استبيان أمانة منطقة المدينة المنورة

1. Full Name: *

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2. Email Address: *

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3. Phone Number: *

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4. LinkedIn Profile: (Optional)

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5. Startup/Project Name: (If you already have a name; if not, leave blank or propose a working title) *

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Website URL: (If available) (Link to your website or online portfolio) *

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One-Sentence Project Description: (In one sentence, tell us what your solution or idea is about) *

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Detailed Project Overview: (Describe your solution or idea. Explain the technology, the problem or opportunity you’re addressing, and your current stage. This accelerator welcomes both well-formed ideas and those still in the brainstorming phase.) *

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Core Team Members: (List the key team members along with their roles and areas of expertise – if you’re still forming your team, let us know how you plan to assemble the right mix.) *

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Relevant Experience: (Briefly describe any previous projects, ventures, or experiences that showcase your ability to execute innovative ideas.) *

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What Problem or Opportunity Does Your Idea Address (You may choose from the options below or describe a new, emerging challenge or opportunity.) *

Traditional urban challenges (e.g., stray animal management, food waste reduction, smart lighting/security, public facility management)

Emerging trends or uncharted problems (e.g., cutting-edge tech applications, new market opportunities, future city planning)

I’m exploring ideas and haven’t defined a specific problem yet

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Alignment & Impact: (Explain how your idea or solution could transform Madinah and contribute to its vision of becoming a tech capital. If your idea is not directly related to current urban challenges, describe its potential for pioneering new markets or technologies.) *

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Current Stage of Development: (e.g., Concept, Prototype, Minimum Viable Product, Early Revenue, or Idea Exploration) *

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Support & Resources Needed: (What do you expect from the accelerator? Options may include mentorship, technical support, funding guidance, market access, team-building support, etc.) *

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Roadmap & Milestones: (Outline your short-term roadmap. For early-stage ideas, describe your vision for development and key milestones you aim to explore during the program.) *

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Prior Funding or Accelerator Experience: (Have you participated in any accelerators or received external funding? Please provide details.) *

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Unique Value Proposition: (What makes your solution or idea unique and compelling? How does it stand out from existing approaches *

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Follow-up Availability: (Are you available for a follow-up interview or pitch session? Yes/No) *

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Additional Comments or Attachments: (Use this section to include any other relevant details or to upload your pitch deck and supplementary materials.)

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Confirmation: o I confirm that all the information provided is accurate and complete. o I agree to the terms and conditions related to this application and consent to being contacted by the Madinah-Tech team. *

I confirm that all the information provided is accurate and complete.

I agree to the terms and conditions related to this application and consent to being contacted by the Madinah-Tech team.

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Madinah-Tech Cultivator Application Form

1. Full Name: *

2. Email Address: *

3. Phone Number: *

4. LinkedIn Profile: (Optional)

5. Startup/Project Name: (If you already have a name; if not, leave blank or propose a working title) *

Website URL: (If available) (Link to your website or online portfolio) *

One-Sentence Project Description: (In one sentence, tell us what your solution or idea is about) *

Detailed Project Overview: (Describe your solution or idea. Explain the technology, the problem or opportunity you’re addressing, and your current stage. This accelerator welcomes both well-formed ideas and those still in the brainstorming phase.) *

Core Team Members: (List the key team members along with their roles and areas of expertise – if you’re still forming your team, let us know how you plan to assemble the right mix.) *

Relevant Experience: (Briefly describe any previous projects, ventures, or experiences that showcase your ability to execute innovative ideas.) *

What Problem or Opportunity Does Your Idea Address (You may choose from the options below or describe a new, emerging challenge or opportunity.) *

Alignment & Impact: (Explain how your idea or solution could transform Madinah and contribute to its vision of becoming a tech capital. If your idea is not directly related to current urban challenges, describe its potential for pioneering new markets or technologies.) *

Current Stage of Development: (e.g., Concept, Prototype, Minimum Viable Product, Early Revenue, or Idea Exploration) *

Support & Resources Needed: (What do you expect from the accelerator? Options may include mentorship, technical support, funding guidance, market access, team-building support, etc.) *

Roadmap & Milestones: (Outline your short-term roadmap. For early-stage ideas, describe your vision for development and key milestones you aim to explore during the program.) *

Prior Funding or Accelerator Experience: (Have you participated in any accelerators or received external funding? Please provide details.) *

Unique Value Proposition: (What makes your solution or idea unique and compelling? How does it stand out from existing approaches *

Follow-up Availability: (Are you available for a follow-up interview or pitch session? Yes/No) *

Additional Comments or Attachments: (Use this section to include any other relevant details or to upload your pitch deck and supplementary materials.)

Confirmation: o I confirm that all the information provided is accurate and complete. o I agree to the terms and conditions related to this application and consent to being contacted by the Madinah-Tech team. *