NOMINATION FORM 2013

Send the completed form to manthanaward@defindia.net You can also fill the form online at http://manthanaward.org
Kindly go through the guidelines before filling the Nomination form. We suggest you to provide the appropriate information for the use of Jury. Please ensure that filled in text is not repeated in the responses against the items in Part I, Part II and Part III. Questions marked with asterisk * are mandatory. However, we recommend filling all fields. Online Form: An applicant is required to fill the mandatory fields in the form for the first time. For editing it further, you can login using your Password & Email ID. Offline form: No further editing would be available, please ensure to fill it properly & finalise before sending it to manthanaward@defindia.net Applicant is required to attach One Project presentation or a small project video about the project/product with this nomination form, otherwise Jury may not consider the application. After filling up the nomination form, if applicant feels to share PPT/Video/Pics about their project they can send it to manthanaward@defindia.net keeping project name in the subject line of the email.

Part I - Overview
1 Name of the Project/Product Nominated (in English)*: 2 Name of the Project/Product in Original Language: 3 Language(s) of the Product*: 4 Website URL*: 5 Links to Online Resources*: 6 Category* [CHOOSE ONE] 1. e-Business & Financial Inclusion 2. Community Broadcasting 3. e-Culture and Tourism 4. e-Education, Learning & Employment 5. e-Agriculture and Ecology 6. e-Governance 7. e-Health 8. e-Inclusion & Localisation 9. e-News & Journalism 10. e-Entertainment & Games 11. e-Science & Technology 12. e- Women & Empowerment (Provide all the material related to the project/product like brochure, ppt, video links, media links, client sites etc.) (Language in which your project is launched ie. Hindi, English, Marathi, Gujarati etc.)

7 Project Definition of the application/service/innovation*: (Not more than 200 Words)

[Define the project/product briefly with its vision & Mission.]

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Part II - Product/Project Data & Details

8 Launch Date of the project*

[PROJECT IMPLEMENTED BEFORE 1ST JANUARY 2013 SHOULD APPLY]

9 Detailed Description of the application / service/ innovation*: 10 Who are currently using your service or product*? Describe the project Objectives & concept in detail.) (Limit: 2000 Words) [Provide who are your End users, Share the specific communities counts as your target market & number of users of your application till date) [Limit: 500 words]

11

What do you deliver (Content/Services) to your customer/target group through your initiative?*

[Provide the Complete list of deliverables to the customer/target group] [Limit: 300 words]

12

Describe the Business model. Is your project sustainable on its own? How scalable is it?*

[Describe details of step by step approach to the project implementation & idea of making it sustainable model] (Limit: 500 Words)

13

Specify your implementations till date & impact on the Society? *

[List Regional areas where the project was implemented & the outcome/impact of the same. Quote quantitative data.] (Limit: 300 Words)

14

What was the background behind developing the application/service/innovation?

[Give details about the factors which motivated you to start this project.] (Limit: 300 Words)

15

What are the Limitations of project*:

[Provide the limitations/issues in implementing the idea on ground.] (Limit: 500 Words)

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Uniqueness in the idea*

[Explain the USPs & strategic value of your project] [Limit: 500 words]

17

Provide some real User Experience (Feedback and comments by the users , preferably with regarding your Innovation. user contact details) [Limit: 500 words]

Part III - Technical Details

18 Technical description of product/ services / platform ( Not more than 200 words)* Technology (Hardware, Software, PlatformLCD, Web, Phone, other device) Feature List (content features/service features of project) Hosting (Details and explanation on how it is fast, scalable, reliable and secure? ) Integration mechanism (with different mobile phones) Edition & Pricing (Editions tailored for the demanding needs of small to large size businesses from different industries) Coverage area Value added services, if any Service & Support (In terms of software, or hardware, if applicable) Any special Device/Equipment required for testing the application*? Installation procedure/Technical Requirements of the product/project for testing by Jury*: (If Yes, send the device to the mentioned New Delhi office address on website) [Provide User name & Password/steps / special browser/plug-in/ Device / any other information required to access & test the product/project]

19 20

21

Sources of funding?

[Name the sources who are funding/supporting your innovation]

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Part IV - Personal (Individual/Organization) information

22 23 24 25 26 27 28 29 30 31 32 Name of Organization (Nominee)* Contact Person* Address* City* Post Code* State* Country* Mobile, Telephone, Fax* Contact/Primary Email* Logo of the Project* PPT of the project* (Attach one Logo in JPEG, .EPS or .PNG format) Max size: 2 MB (Attach one ppt talking about your project definition, objectives, approach & USP for the reference of Jury Members) (Attach one short Video Demo of your project implementation/endusers/ approach/USP for the reference of Jury Members)

33

Video Demo of the project*

34 S.No.

Heads, Team Members, Investors, Clients, Partners & Vendors who have significantly contributed* Name Email Phone/Mobile Location Role [Heads/Team Member/ Client/ Vendor / Investor]

1. 2. 3. 4. 5.

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