ITU Telecom World Awards 2019 Corporate Application Form Sustainable Development (CSR) Please be concise and include only the most essential information necessary for the jury to assess your business. By completing this form, you acknowledge that all information is accurate. * mandatory fields Date1 Eligibility1.1 Please indicate Stand/Pavilion name (and number) or nature of sponsorship at ITU Telecom World 2019:2 Company information2.1 Company name*2.2 Company HQ country*Please selectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaeSwatiniEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwedenSwitzerlandSyriaTaiwan, ChinaTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe2.3 Contact person* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First name Middle name Last name 2.4 Contact Email* 2.5 Company URL* 2.6 Video URL 3 Overview3.1 Solution/project description (what does your product/solution/project do)? What problem does it solve? (max 1800 characters)3.2 Who is the user or beneficiary of the solution/ project? (max 1800 characters)Assessment will be made on: - Clear description of the solution project. - A demonstrated need for the service/project. Is it being adopted by users? 4 Sustainability and scalability4.1 Describe the sustainability model: how is the cost of the project/solution funded? (max 1800 characters)4.2 How many people are using the product/solution/project? Describe what makes it scalable? (max 1800 characters)Assessment will be made on: - The financial sustainability of the solution/ project. - Potential for widespread usage and adoption.5 Innovative use of ICTs5.1 Describe the role of ICT in your solution/project. (max 1800 characters)Assessment will be made on: - How innovative is the use of ICT in the product or service? Does it provide a radical new solution, apply an existing solution to a new market or incrementally improve an existing service (what is important is how effectively your solution solves a user pain).6 Socio-economic / environmental impact6.1 Describe the social-economic or environmental impact of your solution: (max 1800 characters)Assessment will be made on: - Is the potential for existing social impact measurable? - Is the business environmentally sustainable? - Does the product or service have existing or potential widespread social impact (widespread being 100,000 users)7 Upload attachments7.1 Company/product brochure (optional):7.2 Other relevant links (e.g. crowdfunding campaigns, product brochures, app etc.): By submitting this form I confirm that I have read and agreed to the Terms and Conditions of the ITU Telecom World AwardsCAPTCHA Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.