application form for innovation fund 2012

7/28/2019 Application Form for Innovation Fund 2012

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9. Target Beneficiaries

10. Innovation Purpose

11. Innovation Objectives (Clearly give the specific objectives of this innovation)

12. Background(Give brief and sufficient information on activities related to thisinnovation and information from relevant literature)

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13. Relevance of the innovation to national development (Describe the relevance ofthis innovation to national development for example in regard to vision 2030)

14. Innovation Plan and Methods (Describe the plan of activities in a time frame and the

methodology for this innovation project)

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15. Description of Expenditure

Item Description Unit Cost No. Total (Kshs)

i) Equipment to bepurchased

Sub Total

ii) Cost of use of existingFacilities

iii) Travel (Destination,No. of days and

persons)

Sub Total

iv) Personnel Costs

Sub Total

v) Consumables

Sub Total

vi) Other Costs(specify)

Sub Total

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Grand Total

16. Other Sources of Budget if any (Indicate amount and use)

17. Expected Results/Outputs

a) Explain the expected direct results from your innovation activities

b) State any intellectual property or technology transfer benefits expected from the

innovation

c) State what technology or process that will be required for this innovation to bedisseminated

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18. Innovation Project commercialization

a) Indicate any commercial objective and benefits expected

b) Indicate what will be required for commercialization if technically successful

c) State any strengths and weakness of the innovation

d) Dissemination of Innovation (Describe how the innovation will be disseminated to thetarget beneficiaries)

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19. Endorsement by innovation project collaborators

I/We here endorse the innovation project and will carry out the activities as detailed in theproposal.

Name Signature

1. ..

2. .. .3 .4 .

19. Declaration by Project Coordinator

Iaccept to carry out the innovation

activities detailed in the innovation project proposal.

Signature. Date.

FOR OFFICIAL USE

20. Recommendation from the Deputy Vice Chancellor RPE

a) Approved for funding Yes

No

b) If Yes: i) Amounts Kshs...

ii) Project Time Frame .....

c) Other recommendations...

....

......

...

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Name:.Signature.

Date

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application form for innovation fund 2012

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