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Name
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First Name
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Last Name
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Company
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Website
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Email
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Phone
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Product description
Product name
*
Stage
*
Idea or concept yet to be tested
Prototype
Tested prototype
Existing product to be adapted to dementia
Existing dementia product ready to go to market
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Target audience
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People living with dementia
Family and friends of people living with dementia
Professional carer of people living with dementia
Health workers
General population
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Current product focus
*
Dementia-specific
Dementia-friendly
Aging or disability
Other
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Aim: What problem or improvement does the product aim to address?
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Description: Describe your product in 150 words or less
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Impact: To what extent does the product help those living with dementia, families and carers?
*
Supporting media: Include links to any media (illustration, photo or video) describing the product
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Support sought
Type of support
*
Facilitated access to Dementia Advocates
Connections
Partnerships to co-develop
Combination of the above
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Further detail around support sought
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Describe the support being sought
Project partners, sponsors and funding sources
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Please list any support partners or funding for this project
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