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Gender * --- Select Choice --- Male Female
Date of Birth: *
Nationality *
District / Location (must be in the greater Albertine region) *
Email *
Phone Number *
Highest Level of Education: * --- Select Choice --- Primary (P7 or below) O-Level / S.4 or below A-Level / S.6 or equivalent Vocational or Technical Training (Certificate / Diploma) Undergraduate Degree Postgraduate Diploma or Master’s Degree PhD
Institution / Organization *
Occupation / Current Role *
Name of Your Innovation / Project / Startup *
Innovation Track * --- Select Choice --- Track 1: Green & Environmental Innovation Track 2: Agritech & Food Systems Track 3: Digital & Frontier Technologies Track 4: Social Impact & Civic Innovation Track 5: Creative & Cultural Innovation
Brief Description of Your Innovation (max 150 words): *
5. Problem Statement – What challenge are you addressing? (max 100 words): *
Proposed Solution – How does your innovation solve this problem? (max 100 words): *
Who are your target users or beneficiaries? *
Expected Impact or Outcomes (social, environmental, or economic): *
Current Achievements or Milestones (if any):
Is your business or innovation registered? * --- Select Choice --- Yes No
If yes, Registration Type / Number:
Year of Registration:
If yes, please specify program:
13. If Yes (above), please provide specify amount received (UGX / USD):
• Year received:
• Purpose of the funding:
• Key outcomes or results achieved through that support:
Are you applying as an individual or team? * --- Select Choice --- Individual Team
Number of Team Members:
Brief background & Roles of your team (skills, experience, etc.) (Max 1000 words) *
Do you have any accessibility, dietary, or other special needs we should plan for?
Will you require support such as travel or accommodation to attend the Forum? * --- Select Choice --- Yes No
economic): or or
Links to any online features about Your Innovation; Website, Facebook, X, Instagram, YouTube, TikTok, or any other if available (optional)
