Form: Impact Ambassador Scholarship

Your first Name *

Your last/family name *

Your email address *

Please confirm your email address *

Your phone numberPlease include country code.

Your company's namePlease note that you must be affiliated with a non-corporate entity, e.g. a governmental organization, an NGO or a startup.

Your job title Please note that you must be an executive-level employee at your company.

Which program dates are you interested in? *

May 11-13, 2020 in CopenhagenOctober 6-8, 2020 in CopenhagenNovember 16-18, 2020 in Helsinki

You can only select one.

Which seat are you applying for? *

Virtually Physically

SingularityU Nordic is excited to announce the sponsorship of two Impact Ambassador seats. Note: You can apply for a physical seat in a Nordic country. You have to ensure your own travel and accommodation to fully participate in the program. OR A virtual seat where you’ll join via Beam. Beam is a smart tele-presence system that enables you to join activities remotely, move within the physical space and engage with participants and the program in real time.You can only select one.

If you apply for the virtual seat: you will be joining via a technological solution that enables you to move within the space and engage with participants in real time. Therefore, internet support is required. The program will be live in Copenhagen (Central European Time Zone).Yes, ensure to have full internet support to be able to participate while the program is live in Copenhagen. I am not able to have full internet connection. I will physically be there. I understand that I have to ensure my own travel and accommodation to fully participate in the program.

Please share with us which Global Grand Challenge(s) or UN Sustainable Development Goal(s) you are working on solving, how you are tackling the challenge, and why this is important to you. (Maximum 250 words) *

Please tell us why you apply for the program and what is the relevance of the program for you. (Maximum 400 words) *

Please share something from your background/expertise that you think will provide value for the other participants at the program (Maximum 250 words) *

Five years from now, you are on the cover of your favorite magazine because of an achievement that was kickstarted during your participation in the program. What is the headline? *

Areas of Interest: To help us better understand your interests, please select your top interests from the list below. | Exponential Technologies *AI & RoboticsBiotechnology & BioinformaticsEnergy & Environmental SystemsMedicine & NeuroscienceNanotechnology & Digital FabricationNetworks & Computing SystemsNo Specific Interest

Feel free to share anything else you'd like us to know here (optional).

Terms and Conditions. *

To see our Terms & Conditions, visit http://sunordic.org/termsconditions/

I agree to my personal and professional data being captured and stored by SingularityU Nordic (See Terms & Conditions).

Impact Ambassador Application