Application Form — Ignite Life

IGNITE Application

use the form below to submit your application for the IGNITE Challenge. Please note that all fields are required for consideration.

Personal Info

Applicant Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Applicant Occupation

Applicant Education

Sponsoring Organization

Org Address

Org Phone Number

Name of Contact at Sponsoring Org

Email of Contact at Sponsoring Org

FCRA Account

Title of Account

Bank Name

Beneficiary Account Number

IFSC Number

Project Overview

Provide a brief description of the problem you intend to solve and how it will improve 'quality of life' in the community:

Brief abstract of your idea and concept to address the problem described above (250 words or less):

Details

Provide a step by step approach to the research you wish to undertake. Be as specific as possible. (ex: data collection, lab tests, materials required, etc.)

Provide a budget estimate and schedule for each of the steps described above.

Why do you think your outcome will be acceptable and affordable to intended users?

What qualifies you to conduct this research?

Signatures

By typing your name below, you are signing the application to indicate accuracy and completeness of all information provided. Your signature also indicates accuracy and compliance of all sponsors and sponsor organizations listed above.

Date