Kabalega Innovation Activation Forum Registration Form

Full Name

First

Last

Gender

Date of Birth:

Nationality

District / Location (must be in the greater Albertine region)

Email

Phone Number

Highest Level of Education:

Institution / Organization

Occupation / Current Role

Name of Your Innovation / Project / Startup

Innovation Track

What stage is your innovation currently at?

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):

Are your (max

Is your business or innovation registered?

If yes, Registration Type / Number:

Year of Registration:

Have you previously participated in any innovation or entrepreneurship program?

Yes
No

If yes, please specify program:

Have you received any funding, grants, or investment for this innovation before?

Yes
No

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:

What kind of support would be most useful for your innovation? (Check all that apply)

Are you applying as an individual or 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?

Preferred mode of communication:

Email
Phone
WhatsApp

Links to any online features about Your Innovation; Website, Facebook, X, Instagram, YouTube, TikTok, or any other if available (optional)

How did you hear about this Youth Innovation Forum?

Consent & Declaration

I hereby declare that the information provided above is true and accurate to the best of my knowledge. I understand that providing false information may lead to disqualification. I consent to the use of my data for the purpose of processing this application and for communication related to the Youth Innovation Forum 2025. If shortlisted or selected for funding and further Forum engagements, I hereby also grant Kabalega Foundation and its partners permission to use the information provided, and other innovation-related materials (including voice, photos, videos, and descriptions) captured during the Youth Innovation Forum 2025 for purposes of communication, publicity, and promotion of Forum activities, in print and digital media.

Youth Innovation Forum Registration

Kabalega Youth Innovation Forum Registration Form

Secretariat / Support Desk

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