Name:

Organization Contact
Information

Wish List (Include all items you
wish your solution could have):

Logo (Under 10mb, and
min. 72 pixel/inch):

Web Address (URL):

Describe your challenge
problem/opportunity:

Turn your challenge into
a 'How' statement:

Summarize your problem
in no greater than 10
bullet points:

Resources
(Any thing related to your
challenge. Ex. PDF Articles,
Websites, Links...):

Videos (Please provide any
links to promo videos your
organization uses):

Your Contact Email

I agree to be a challenge supporter for the AppsForHealth 2012 event. I agree that my name
and the institution I represent may be published in promotional materials by Mohawk College, before, during and after the conference.

I understand that there is no direct fee or remuneration for participation in this activity.
I understand that the college does not expect or require any intellectual property as part of
my participation and any intellectual property created by students with my support will
become the property of Mohawk College for use in the AppsForHealth Challenge.

Challenge Supporter Application

I Agree

Are you a registered organization? Do you have a health care challenge that needs a technological solution? We want to hear from you.