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Innovation Program Application Form
Provide Application Details
Download hard copy
for working offline. It is recommended that you return to this online form to submit your application.
Please complete this form to apply for the Innovation Program. Please discuss your application with your manager or executive sponsor prior to applying. The information you provide will be used to assess your application
Application Title *
Tell us about your idea/project (max. 2000 characters) *
Provide a case for change (max. 2000 characters) *
Detail the cost (max. 1000 characters) *
Please list how you will implement the project (max. 2000 characters) *
How will you measure/evaluate your project (max. 2000 characters) *
Additional comments/references (max. 2000 characters) *
Please name your manager or executive sponsor that supports your application.
This is to ensure you have support if you are successful and a copy of your application will be sent to them.
Your Contact Details
By submitting this application you acknowledge to accept
Innovation Program Terms and Conditions
Provide a catchy title for your idea/project
Tell us about your idea-project
Give a description of the idea/project, include the following information: What is it? How would it work? Who would use it? Where would it be used? Is the idea new to NSLHD?
Provide a case for change
What problem does the idea/project address? What will be the result if we stay the same?
Detail the cost
Total cost $
List key steps, time frames and who will be involved.
Please list how you will implement the project (max. 2000 characters)
How you will implement
List key steps, time frames (must be implemented within 1 year) and who will be involved.
How will you measure-evaluate your project
What are the key outcomes? How will you measure them? E.g. audit, survey or review. Also include if you have or will engage consumers in your project.
Team Member Names
If you are submitting on behalf of a team, please list your team members names and positions.
Indicates whether user has been notified and if application has been reviewed.