Quantum For Health Design Challenge Application Form

1. Title*

2. Primary contact name*

First Last

3. Primary contact email*

4. Team members*

Please choose the applicable UW affiliation for each member of your team: Undergraduate Student, Graduate Student, Postdoctoral Fellow, Faculty, Staff, Other (please specify). Please choose the applicable pronouns for each member of your team: She/her, He/Him, They/Them or Other (please specify). TQT promotes EDI in team composition. The pronouns will be used to properly identify individuals, should your team be selected for an award.

Name	UW Affiliation	Pronouns

5. What question does your solution address?*

6. What is the impact of the proposed solution, including in the near term (3-5 years)?*

7. Why are quantum technologies a path to achieving this outcome?*

8. What is needed to make this a reality?*

9. What is the market potential and economic feasibility for your proposed solution?*

10. Design Abstract*

Please provide a 150-word abstract in common language and without any proprietary information. This will be used for public communication.

11. Design Submission*

Describe your design including the form, operation, application and its proposed impact in roughly five (5) pages, and no more than ten (10) pages. Your description should speak to both the quantum and health communities (there will be reviewers drawn from both communities). The inclusion of at least one figure is desirable.

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

12. Does your design submission include information that you wish to remain confidential*

Yes
No

Name

This field is for validation purposes and should be left unchanged.

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Quantum For Health Design Challenge Application Form

Quantum For Health Design Challenge Application Form