Legatum Center for Development and Entrepreneurship: Fellowship Application

Transcription

1 Legatum Center for Development and Entrepreneurship: Fellowship Application Application Requirements To submit a complete application, you need to: - Complete the applicable form - Provide a letter of recommendation - Upload your resume or CV You can save and edit your application before the deadline or until you submit it. If you require technical support, such as having problems logging in, please tech@fluidreview.com. If you have non- technical questions, such as how to answer certain questions, please contact legatum- fellowship@mit.edu or *All character limits stated in the application form include spaces Personal Information First Name Middle Name/ Middle Initial Last Name Country of Citizenship Geographic Region Country of Permanent Residence (If different from country of citizenship) Geographic Region Age Gender

2 Do you hold dual citizenship? Please identify your country of dual citizenship Have you applied for any of the Legatum Center s programs in the past? Identify the program and year that you previously applied to: Contact Information Street Address City State/Province/Region Country Postal Code Phone Number (include country code) Address Skype ID Google Hangout ID LinkedIn Page

3 MIT Enrollment Status Please select your current MIT status Enrolled MIT graduate student Enrolled MIT undergraduate student Enrolled MIT undergraduate student applying to MIT graduate program n- MIT student applying to MIT graduate program Recently accepted to an MIT graduate program for the upcoming academic year Previously accepted, but deferred to the upcoming academic year t enrolled, accepted, or applying to a MIT degree program for the upcoming academic year When did you apply/when will you apply? (MM- YY) / / (YYYY/MM/DD) When were you accepted? (MM- YY) / / (YYYY/MM/DD) When were you previously accepted? (MM- YY) / / (YYYY/MM/DD) MIT Information Which MIT school will you be applying to/enrolled in next academic year? School of Architecture and Planning School of Engineering School of Humanities/ Arts and Social Sciences Sloan School of Management School of Science Other

4 Please explain. What degree program will you be pursuing at MIT next academic year? Bachelor of Science, S.B. Doctor of Philosophy, Ph.D. Doctor of Science, Sc.D. Engineer's Degree, Eng. Master in City Planning, M.C.P. Master of Architecture, M. Arch. Master of Business Administration, M.B.A. Master of Engineering, M. Eng. Master of Finance, M.Fin. Master of Science, S.M. Other Please explain. If Sloan MBA, are you in the entrepreneur and innovation track? What will your field of study at MIT be next academic year? Please explain.

5 Anticipated graduation date from MIT (MM- YY): / / (YYYY/MM/DD) Are you a dual degree applicant? For Dual- Degree Applicants To which MIT school are you applying/enrolled/accepted for your second degree? MIT Sloan- Harvard Kennedy School MIT- Wellesley College MIT- WHOI Joint Program in Oceanography and Applied Ocean Science and Engineering School of Architecture and Planning School of Engineering School of Humanities/ Arts and Social Sciences School of Science Sloan School of Management Other Please explain. What is the degree program for your second degree? Bachelor of Science, S.B. Doctor of Philosophy, Ph.D. Doctor of Science, Sc.D. Engineer's Degree, Eng. Master in City Planning, M.C.P. Master of Architecture, M. Arch.

6 Master of Business Administration, M.B.A. Master of Engineering, M. Eng. Master of Finance, M.Fin. Master of Science, S.M. Other Please explain. What is the field of study for your second degree? Please explain. Anticipated graduation date of second degree (MM- YY) / / (YYYY/MM/DD) Business/Entrepreneurial Idea Name of Business/Idea Country of Implementation Geographic Region This business is For- Profit n- Profit Hybrid: For- Profit & n- Profit Undecided Industry/Sector Agriculture Apparel & Accessories

7 Automotive Chemicals Consumer Goods Education Energy/Utilities Food & Beverage Financial Services Heathcare/Pharma IT/Telecom Law/Legal Services Manufacturing Media Professional Services Real Estate Retail & Wholesale Transportation Tourism & Entertainment Your Business's Website Your Business's Twitter Handle Your Business's Facebook Page Provide a brief description of the business/idea you hope to refine as a Legatum Fellow and implement upon graduating from MIT: (Limit 1000 Characters) What stage is your business/idea? Idea Stage Proof- of- concept/pilot Stage

8 In Operation (with revenue and customers) How long have you had this business/idea? 1 to 2 years 2 to 3 years > 3 years Who is your target customer? (Limit 150 Characters) What market opportunity or need does your business address? What is the estimated size and value of the market? (Limit 1000 Characters) How will your venture be profitable? What is your revenue model? (Limit 1000 Characters) Describe how you plan to grow/scale your business. (Limit 1000 Characters) Describe how your venture is innovation- driven. (Limit 1000 Characters) (Innovation includes a new technology, method of delivery, innovative solution using traditional means, targets a non- traditional population, or uses innovative marketing techniques.)

9 Do you have co- founders or a team? Include their respective roles and a brief description of their backgrounds (education, relevant work experience, in- country experience, etc.). (Limit 1000 Characters) Describe the profile of the first one to three team members you would like to find. (Limit 1000 Characters) Is a member of your team also applying for the Legatum Fellowship? What is his/her name? How different is your product/service from that of your competitors? Why would a potential customer pick yours over your competition s? (Limit 1000 Characters) Have you lived in or visited the country where you intend to launch or scale your enterprise?

10 For how long and in what capacity? (e.g. native of the country, studied there, worked there, volunteered, etc.) (Limit 500 characters) Is a member of your team or an advisor familiar with the country, and in what capacity? (Limit 500 Characters) Please state her/his name and your relationship with this person. Have you lived in or visited another low- income country? Which country, for how long and in what capacity? (Limit 500 Characters) What key challenges or risks do you see as potential threats to starting or growing your venture? (Limit 1000 Characters) (e.g. you and the team s skills and knowledge, capital, technology, industry, market, legal, socio- cultural values, etc.) Have you raised funding for this venture? How much? (In USD)

11 Select all that apply Friends and Family Angel Investors Venture Capital Other, please specify... Have you participated in a business plan competition with this idea? If, which one(s), when, where, and what was the outcome? (Limit 500 Characters) What milestones do you plan to achieve (e.g. develop a team, develop a working prototype, incorporate, secure funding, etc.) Six months from now? (Limit 300 Characters) A year from now? (Limit 300 Characters) A year- and- half from now? (Limit 300 Characters) Two years from now? (Limit 300 Characters) What specifically do you hope to get out of the Legatum Fellowship? (Limit 1000 Characters)

12 FINANCIAL RESOURCES What is the total estimated cost (in USD) of your MIT program for the academic year? Do you have additional fellowships, scholarships, sponsorships, or other financial support (including personal and family funds) that you anticipate using to support your studies at MIT? The Legatum Center encourages you to apply for additional financial support so that the Center can make its resources available to other worthy candidates as well. Source 1: Please include the name of the source and the amount. Source Name Amount (USD) Confirmed? Do you have additional resources? Source 2: Please include the name of the source and the amount. Source Name Amount (USD) Confirmed?

13 Do you have additional resources? Source 3: Please include the name of the source and the amount. Source Name Amount (USD) Confirmed? Do you have additional resources? Source 4: Please include the name of the source and the amount. Source Name Amount (USD) Confirmed? Do you have additional resources? Do you have more than four sources? How much financial support (in USD) are you seeking from the Legatum Fellowship?

14 Short Essays Why do you want to be an entrepreneur/why are you an entrepreneur? (Limit 1000 Characters) Describe an experience that reveals your entrepreneurial or enterprising qualities. (Limit 1000 Characters) Describe an experience that reveals your management or leadership qualities. (Limit 1000 Characters) How does your background (educational, professional, etc.) relate to your business? (Limit 1000 Characters) Successful entrepreneurship requires commitment; describe an experience that highlights your ability to commit to a long and/or difficult project. (Limit 1000 Characters) Additional Information for the Selection Committee: if you have additional activities, work experience, and/or awards that you believe are relevant to your application, please list those you consider most significant. Please include any pending or issued patents. Limit 1000 Characters

15 Additional Questions Do you know a Legatum Fellow? What is his or her name? How did you hear about the Legatum Fellowship? (Check all that apply) Legatum Center's Lecture Series (Please state the topic or speaker) Conference at MIT (Please indicate year) Newsletter (Please specify sender) Website Other Websites MIT Sloan School of Management Martin Trust Center for MIT Entrepreneurship MIT Office of Graduate Admissions - General Site Other (Please specify) Social Media / Advertisement (Please specify page source or location) Facebook Twitter LinkedIn Article, Flyer, Radio

16 Other Direct Contact (Please specify who) Legatum Fellow/Alumni MIT Faculty/Staff MIT Student or Alumni MIT Organization or Club n- MIT Contact Other Contact (Please specify event location and date) Information Session at Career/Recruiting Fair at Conference at Other Would you like to opt- in to the Legatum Center mailing list? By signing below, I certify the information I have provided to be accurate.