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Senders identification
Title
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miss
Miss
mr
Mr
mrs
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First Name
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Last Name
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Street and Number
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Zip Code
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City
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Region
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Wallonie - Belgium
Meurthe-et-Moselle - France
Moselle - France
Rhineland-Palatinate - Germany
Saarland - Germany
Luxembourg - Luxembourg
Phone
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Phone 2
Fax
E-Mail
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Birthdate
(dd/mm/yyyy)
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Studies and Specialization
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Occupation
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Other
Employee
Independent
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Researcher
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Other (please specify):
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Where did you hear first about the program?
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Local Partner
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Internet
Media (Newspapers, Radio, TV)
Poster
University(ies)
Other (please specify):
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Project identification
Project name
(Required)
(200 characters max.)
Region
(Required)
-
Wallonie - Belgium
Meurthe-et-Moselle - France
Moselle - France
Rhineland-Palatinate - Germany
Saarland - Germany
Luxembourg - Luxembourg
Language
(Required)
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de
German
en
English
fr
French
Activity domain
(Required)
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Handicraft
Agro-alimentary
Automatism-robotics
Banking
Biotechnology
Computer science
Construction
Sustainable Development
Energy
Environment
Finance
Industry
Insurance
Internet
Leisure
New Materials
Media
Medicine
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Other
Pharmacy
Human Ressources
Commerce
Telecommunication
Other (please specify):
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Company already created?
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Yes
No
Are you already in contact with another organisation that supports start-ups?
(Required)
Yes
No
If yes, which one?
Project description
Please describe your project in one sentence
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(200 characters max.)
To what need does your project bring a solution?
(Required)
(1500 characters max.)
Description of your product/service
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(1500 characters max.)
How does your project differenciate itself from its competitors?
(Required)
(1500 characters max.)
Innovation of your project
(Required)
(1500 characters max.)
What is your business model? How is your company going to earn money?
(Required)
(1500 characters max.)
Description of the targeted market and his potential
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(1500 characters max.)
Description of your team
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(1500 characters max.)
Which partners are associated to the project ?
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(1500 characters max.)
How do you plan to finance your project (short and middle term)?
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(1500 characters max.)
Why did you choose to submit us your project?
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1,2,3 GO Social
Nyuko Learning
1,2,3 GO
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If you want to participate at the 1,2,3 GO contest, could you please describe the innovation of your project:
If you want to participate at the 1,2,3 GO Social contest, could you please describe the social problem your project means to solve :
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