Chia Form

TANZANIA HEALTH SUMMIT 2024

CHIA FORM

Please fill the form below and all applications must reach CHIA’s mailbox on or before
Saturday, June 1^st 2024,

Nomination Form

Project Title

Name of Applicant

Email Address

Phone Number

Region

Challenge

Solution

Objectives

Innovativeness

Budget, Funding & Reporting Structure

Name of main Applicant

Link of video showing your innovation

Copy of Identity (passport, driving license or national ID)

Referee Letter with his/her contantact information

Agreement

BY SIGNING THIS CONCEPT NOTE FORM, YOU ARE DECLARING THAT YOU HAVE CHECKED AND VERIFIED THE INFORMATION PROVIDED THEREIN TO BE TRUE IN SUBSTANCE AND FORM. SUBSEQUENTLY, ANY INFORMATION FOUND TO BE UNTRUE WILL RENDER THE CONCEPT NOTE NULL AND VOID.

TANZANIA

HEALTH

SUMMIT

OCTOBER 1 - 3, 2024

TANZANIA.

TANZANIA HEALTH SUMMIT 2024

CHIA FORM

Nomination Form

About

What We Do

Other

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