Innovation Hero Nomination Form

About you (the person making this nomination)

Your name (required)

Your email (required)

Your contact phone number

Your full address

Your company or organisation

About the person being nominated

Their name (required)

Their email (required)

Their contact phone number

Their company or organisation

Their position or role

Their full address

About the nomination

Describe the owners of the company and all other significant investors

Describe the innovation being submitted for this award.

Was the technology conceived and developed in Australia?

Why is the technology superior to alternatives that may exist?

What is the status of its use or commercialisation?

What monetary benefits has this innovation generated (sales, profitability)? What other funds have flowed to Australia? Quantitative information is required.

What benefits has the innovation bought to Australia? Include consideration of satisfaction of community aspirations (e.g. social and/or environmental impact).

Are there any significant issues or problems associated with this innovation or its commercialisation?

State what the intellectual property rights are for this innovation.

What other recognition has been afforded to this product, service or innovator?

References

Please fill in the details of two independent referees who can vouch for this technology.

Referee 1

Referee 1 name (required)

Referee 1 email (required)

Referee 1 phone number

Referee 1 company or organisation

Referee 2

Referee 2 name (required)

Referee 2 email (required)

Referee 2 phone number

Referee 2 company or organisation

Prove you aren't a robot