Submissão ao Concurso DIMA’thon

1. Participant Information

Name

Phone Number

Organization/Institution:

Title/Position:

2. Innovation Overview

Title of Innovation:

Brief Description (Max 250 words):

0 of 250 max words

Stage of Development: (Idea, Prototype, Pilot, Market-ready)

Target Impact Area:

Maternal Health Access

Maternal Health Services

Data Analysis & Visualization

Stakeholder Engagement

Other

3. Detailed Description

Problem Statement:

Proposed Solution:

Innovative Features:

Impact on Maternal Health Outcomes:

4. Supporting Materials

Links to Videos, Demos, or Websites (optional):

Attach Documents (Business Plans, Research Papers, etc.) (optional):

Maximum file size: 516MB

5. Funding and Resources

Current Funding Status:

Funding Requirements:

6. Intellectual Property

Additional IP Information (if any):

7. Additional Information

Team Members and Roles:

Partners and Collaborators:

Indemnity and NDA Agreement

By submitting this form, you agree to the following terms:

Indemnity Clause: You agree to indemnify and hold harmless DIMA Health and its affiliates, partners, and sponsors from any claims, losses, liabilities, damages, expenses, or costs arising from your participation in the competition and the use of your submitted materials.

Non-Disclosure Agreement (NDA): DIMA Health commits to protecting your confidential information. All submitted materials will be treated as confidential and will not be disclosed to any third party without your consent, except as necessary for the evaluation of your submission and the administration of the competition.

Intellectual Property Rights: All intellectual property rights associated with your submission remain with you. DIMA Health will not claim ownership over your innovation but will have the right to use your submission for competition-related activities, including promotion and showcase on the DIMA Innovations Database.

For detailed information on measures to protect participants' intellectual property, please visit this link:

I agree to the terms and conditions.

Signature and Date:

Signature

Clear

Date

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Modelo de Submissão de Concurso DIMA'thon

Por favor, preencha o seguinte formulário para participar no Concurso de Inovação em Saúde DIMA. A sua submissão será analisada pelo nosso painel de especialistas e as inovações selecionadas serão apresentadas na Base de Dados de Inovações DIMA.

Formulário de Submissão