Delta Innovator Search Application Form

Applicant Name(Required)

First Last

Applicant Email Address(Required)

Applicant Phone Number(Required)

Applicant Address(Required)

Applicant Street Address Applicant Street Address 2 Applicant City of Residence Applicant State/Province

Applicant County of Residence(Required)

Business Name (if applicable)

Business Address (if applicable)

Street Address Address Line 2 City State / Province / Region

Business Phone Number (if applicable)

Team Member Names (if applicable)

Briefly describe your innovative idea or solution.(Required)

Describe the real-world problem that your solution addresses, including how it will impact the daily life of a Delta resident and contribute to better health outcomes.(Required)

Why are you personally interested in addressing the problem and what do you hope to gain from participation in the Delta Innovator Search?(Required)

Upload a short video (less than three minutes) that answers the following prompts in this order:

-The problem your idea or solution addresses.
-Customer discovery conducted to validate the problem your solution addresses.
-Description of your potential customers or users.
-Any alternatives to this solution that already exist.
-Outline your innovative idea or solution.
-Metrics used to measure success.
-Summary of your unique value proposition.
-Anticipated barriers to implementing the solution.

(File upload)(Required)

Max. file size: 1 GB.

What is your racial and/or ethnic identity?(Required)

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

Prefer Not to Say

What is your gender identity?(Required)

Male

Female

Prefer Not to Say

Are you a U.S. veteran?(Required)

Yes

Prefer Not to Say

Please be patient when submitting to allow time for the video upload to complete.

1401 West Capitol Suite 300 (Victory Building) Little Rock, AR 72201 Phone: 501-526-2244 Fax: 501-526-2252

1401 West Capitol Suite 300 (Victory Building) Little Rock, AR 72201

Phone: 501-526-2244

Fax: 501-526-2252