Innovate Salone An Initiative of Global Minimum 73 Siaka Steven Street Freetown, Sierra Leone [email protected] +23276308337 School Name & Project Name: .................................................................... ..................................................................... School Category: € National € Provincial € District School Location: € Urban € Rural € Other € Private 2015 INNOVATE SALONE PROGRAM APPLICATION FORM Innovate Salone The Innovate Salone “A de mek am” Challenge empowers local youth to create and implement their own solutions to pressing problems in their communities. Our vision is to expand a culture of innovation and self-efficacy that can help drive economic, social and human development in Sierra Leone. Innovate Salone is independently funded by Global Minimum Inc., individuals, public and private institutions. Donated resources help with the organization of the program, support and implementation of the best ideas and maintaining a network of innovators and social entrepreneurs in Sierra Leone. The Program Youth are encouraged to work in teams of 2 - 3 for the Innovate Salone program. Up to 10 teams will be selected by an acclaimed panel of international and local judges for a fully-funded 2-month program of workshops, field-trips, mentorship and seed-funding to produce a prototype of a solution for a well-defined local problem. Teams will need to provide details of how the prototype will be developed and why they are well suited to accomplish the project. Each team will be assessed based on their project proposal and recommendation from the school nominating them. At the end of the application cycle, up to 10 finalist teams will be selected as participants. Project Submission & Finalist Announcements To apply, each team must submit their application form by June 27th, 2015 to the email address [email protected], or mail the application to: Innovate Salone: C/O Mahmoud Javombo 73 Siaka Steven Street Freetown, Sierra Leone For questions regarding the application, contact the following people in your respective province/city/district/town; Freetown (South) – Mahmoud Javombo | 076 308 337 Freetown (West) – Ibrahim Tucker | 078 290 685 Makeni (North) – Morrison Yayah Kamara | 076 955 440 Kenema (East) – Christopher Mansaray | 076 867 925 Selected participants will be announced on July 17th, 2015. Attached to the application must be a list of team members, a list of advisers, and a recommendation letter from a school. The proposal should include all of the following: 1. 2. 3. 4. 5. 6. 7. 8. Introduction: A brief overview of your project. (Maximum 100 words) The Challenge: What is the challenge/problem that your team is trying to solve through this innovation competition? (Maximum 100 words) Problem Motivation: Why is this problem important? (Maximum 150 words) Proposed Solution: How are you planning to fix this problem? What is your approach? Is your approach scalable? (Maximum 250 words) Other Solutions: What other community solutions which address this problem? Is there anything similar to your solution? Please list them here. (Maximum 250 words) Detailed Budget: What would the costs be to completing your project? Plan of Action: What steps are you planning on taking to make this project a reality? Resources needed: Please list resources needed to accomplish your project. This should include resources you currently have and other resources you will require. The deadline to submit a proposal by email, mail, or in-person is June 27th, 2015, by 5:00PM. You may use the below form for your application to this competition. Alternatively you can copy the questions and answer them in a separate document. Feel free to attach additional information if necessary. Please fill out all sections of this form. APPLICATION FORM 1: Team members: Please list the name and class of all team members and their assigned roles, i.e. Team Leader, Accountant, Designer, Project Assistant. Name Role Gender Birthdate Grade Phone Email *Please note that each team has to have a team leader 2: Team Mentors: Please list the name of teachers or faculty members that will serve as mentors or contact person. Include phone and e-mail. Name Designation Phone Email 3: Team Contact & School Information: Email (if any), Telephone number and School Address: 4: € € € € € € How did you hear about Innovate Salone? (Please tick all that apply.) Facebook Another Student Teacher/ School Faculty Member Poster in School School Announcement/ Presentation from Innovate Salone Representative Other: _______________________ 5: Introduction: Please provide a brief overview of your project. (Maximum 100 words) Include the sector of your project as well: € Agriculture/Food € Engineering € Science € Arts & Design € Environment € Civic Media/Visual Arts € Health/ Healthcare € Education € Telecommunications € Energy € Water & Sanitation € Other (Please describe): 6: The Challenge: What is the challenge (problem) that your team is trying to solve through this innovation competition? (100 words) 7: Problem Motivation: Why is this challenge important to solve? (150 words) 8: Proposed Solution: How are you planning to address this challenge? Where will you do it, who will you work with, how will you engage your community? Describe the model you want to design. Include or attach a diagram/illustration or photos of the project if possible. (250 words) 9: Other Solutions: What are other community solutions which address this problem? How does your project differ? Please briefly describe them here. (250 words) 10: Detailed Budget: What would the cost be to complete your project? Attach additional materials if needed. Material Description Quantity Cost e.g Plastic pipe PVC plastic pipe 3 x SLL 1800 SLL 5,400 Total 11: Plan of Action: What steps are you planning on taking to make this project a reality? What is the timeline in which you will finish the design? Include goals that your team has set for each week to complete your project. 12: Resources needed: Please list resources needed to accomplish your project. This should include resources you currently have and other resources you may require. 13: RECOMMENDATION/ATTESTATION FORM This form must be filled out by the Principal or Deputy Principal of the school. Please provide a reasonable recommendation for the team. Please indicate why you think this team should be nominated to receive funding for the Innovate Salone competition. Please feel free to attach additional pages if necessary.
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