Phoenix Implementation Award

Section 1: Basic Information

Name (Organizational Applicants)^* :

Organisation Category^* :

Email Address^* :

Mobile no^* : +91

Website :

Linkedin Profile Links :

City^* :

Country of Operation^* :

Brief Overview (Individual or Organization) ^*(Max 200 words) : (Describe your role and contributions to the healthcare ecosystem Provide an overview of your mission, vision, and key contributions to enabling the healthcare ecosystem)

Section 2: Contributions to the Ecosystem

Role as a Catalyst^* : (Explain how you or your organization support the healthcare ecosystem (e.g., mentorship, funding, infrastructure, policy support, knowledge sharing, etc.)

Initiatives or Programs Supported^* : (Max 300 words) (List the key initiatives, programs, or projects you have enabled. Provide a brief description for each)

Impact Created^* : (max: 300 words) (Describe the measurable impact of your contributions, such as improved innovation, enhanced collaboration, or increased accessibility in healthcare)

Challenges Addressed^* : (Max 300 words) (Explain the challenges you identified in the ecosystem and how your efforts addressed them)

Collaboration and Partnerships: (Highlight any notable collaborations or partnerships that amplify your impact)

Why Should You Be Chosen for This Award?^* : (max: 300 words) (Summarize what sets you or your organization apart as a catalyst in the healthcare ecosystem)

Section 3: Supporting Documentation

Please Upload your Google Drive link: (Examples: Reports, Program Documentation, User Testimonials, Photos, Videos, etc.)

Awards or Recognition: (List prior awards, certifications, or recognitions related to your contributions as an enabler.)

References: (Provide names and contact details of individuals or organizations who can vouch for your contributions)

Additional Notes:-

1) Applicants can save their progress and resume later.
2)Confirmation emails will be sent summarizing all submitted information.
3)Selection criteria focus on contributions to the ecosystem, measurable impact, collaboration, and sustainability.

Declaration:-

I confirm that the information provided is accurate to the best of my knowledge.

I agree to the terms and conditions for participating in the award selection process.

Application Form: Phoenix Implementation Award for HealthInnovation