Innovator Support Request Form

This Innovator Support Request Form is for innovators in the “Expansion” and “Sustainable Growth” stages of maturity who are seeking to work with VillageReach. This form aims to collect essential information about an innovator’s products/services. Please fill in the fields below to the best of your knowledge. For each section, you can either enter the information directly or provide a link to an online resource. The information provided will remain strictly confidential.

Completing this form will allow us to assess the fit between your needs and VillageReach services.

Innovator Support Request Form

I. Basic information

Instructions: This form aims to collect essential information about your organization and products/services. Please fill in the fields below to the best of your knowledge. For each section, you can either enter the information directly or provide a link to an online resource. The information provided will remain strictly confidential.

1.1 Innovator name

1.2 Innovator description

1.3 Ownership and Management Team

1.4 Funding structure and sources

1.5 Objectives and Priorities: What are the innovator’s current goals and strategic objectives? Are they likely to evolve?

1.6 Product/Service Overview: Detailed description of the innovator’s product or service, including year of commercialization, primary functions/features. May include details such as accessories, lifetime, energy and facility requirements.

II. Consulting service desired by innovators

2.1 Target Service: What service is the innovator interested in obtaining support on?

Market development

Product/Service customization

Product/Service Evaluation

III. Company maturity viability

3.1 Maturity Level: Where is the innovator in its lifecycle (Ideation, Product Development, MVP, Expansion, or Sustainable Growth)?

3.2 Commercial Viability: Is the innovator self-sustaining (bootstrapping) or in need of funding?

3.3 Value Framework: How does the innovator define, create, deliver, and capture value (including details on value proposition, customer engagement, and revenue models)?

IV. Product/Service maturity and attractiveness

4.1 Technology maturity: Does the product/service include any unproven technology? If so, what is to be proven and what is the expected timeline?

4.2 Product/Service maturity: Has the product/service already been sold and implemented? If yes, (a) Since when, (2) what volumes, and (3) who are the named customers?

4.3 Equity: How the product/service ensures there are no biases that might encourage the development or increase of equity problems in health care delivery?

4.4 Data Security: How is user data protected and secured? Are there adequate data privacy policies and regulatory compliance measures in place? Focus on cybersecurity, digital security and/or biosecurity.

4.5 Climate Change: How does the product/service’s design, implementation and operation affect the environment and climate change?

V. Innovator potential market

5.1 Current Market: Who are the innovator’s current clients? In which countries is the innovator operational, and what is the scope of those operations?

5.2 Target Market (Countries): What countries does the innovator target?

5.3 Regulatory Compliance: Does the product/service meet relevant healthcare and related regulations and standards for the target markets?

5.4 Target Market (Buyers and Payers): Who is the primary buyer for the innovator’s products/services? Who is the primary payer for the innovator’s products/services?

Support Our Mission

Your tax deductible contribution helps to increase health care availability to reach the most under-reached.

Donate Today