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Pilots & Research Inquiry Form
Thank you for your interest in piloting Agnes or collaborating on research with the Agnes Consortium. Please fill out this short form, and our team will follow up with you within 3 business days.
Section 1: Basic Information
1. Your Name
*
2. Organization / Company Name
*
3. Your Role
*
4. Email Address
*
5. Phone Number (Optional)
Section 2: Inquiry Type
6. What kind of collaboration are you interested in?
*
6. What kind of collaboration are you interested in?
A
Pilot deployment of Agnes
B
Research collaboration
C
Both pilot and research
7. If ‘Pilot’ or ‘Both’, what setting are you thinking of?
8.If ‘Research’ or ‘Both’, what is your research focus?
Section 3: Goals & Scope
9.What are your primary goals for this collaboration?
*
10.Which geographic area or population do you serve?
*
11. What resources or infrastructure can you bring to the table?
*
12. Do you have a preferred timeline for this project?
*
13. Are there any ethical, legal, or regulatory requirements we should be aware of?
*
Is there anything else you'd like us to know or ask about?
Submit
