LegatumCenterforDevelopmentandEntrepreneurship:FellowshipApplication2018-2019ApplicationRequirements

Tosubmitaneligibleapplication,youneedto:

-Completethe2018-2019applicationform

-UploadyourResume/CV(1pagemax)

PersonalInformationFirstName

MiddleName/MiddleInitial

LastName

PreferredName

CountryofCitizenship

GeographicRegion

CountryofPermanentResidence(Ifdifferentfromcountryofcitizenship)

GeographicRegion

Age(optional)

Gender(optional)

Doyouholddualcitizenship? Yes

No

Pleaseidentifyyourcountryofdualcitizenship

HaveyouappliedforanyoftheLegatumCenter’sprogramsinthepast? Yes

No

Identifytheprogramandyeartowhichyoupreviouslyapplied:

ContactInformationStreetAddress

City

State/Province/Region

Country

PostalCode

PhoneNumber(includecountrycode)

EmailAddress

SkypeID

GoogleHangoutID

LinkedInPage

MITEnrollmentStatus

PleaseselectyourcurrentMITstatus EnrolledMITgraduatestudent

EnrolledMITgraduatestudentbeginningadifferentMITgraduatedegreenextacademicyear

EnrolledMITundergraduatestudent

EnrolledMITundergraduatestudentacceptedintoanMITgraduateprogram

EnrolledMIT5-yearcombinedundergraduateandgraduatedegreestudent

Non-MITstudentacceptedtoanMITgraduateprogram

Non-MITstudent(applicationpending)

WhatisyourMITID?

Pleaseprovidetheemailaddressandcontactinformationyouprovidedforthatapplication

Pleaseuploadyouradmissionsletter

MITSchoolInformation

InwhichMITschoolareyoucurrentlyenrolled? SchoolofArchitectureandPlanning

SchoolofEngineering

SchoolofHumanities/ArtsandSocialSciences

SloanSchoolofManagement

SchoolofScience

Other

Pleaseexplain.

Whatdegreeprogramareyoucurrentlypursuing? BachelorofScience,S.B.

DoctorofPhilosophy,Ph.D.

DoctorofScience,Sc.D.

Engineer'sDegree,Eng.

MasterinCityPlanning,M.C.P.

MasterofArchitecture,M.Arch.

MasterofBusinessAdministration,M.B.A.

MasterofEngineering,M.Eng.

MasterofFinance,M.Fin.

MasterofScience,S.M.

Other

Pleaseexplain.

InwhichMITschoolwillyoubeenrollednextacademicyear? SchoolofArchitectureandPlanning

SchoolofEngineering

SchoolofHumanities/ArtsandSocialSciences

SloanSchoolofManagement

SchoolofScience

Other

Pleaseexplain.

WhatdegreeprogramwillyoubepursuingatMITnextacademicyear? BachelorofScience,S.B.

DoctorofPhilosophy,Ph.D.

DoctorofScience,Sc.D.

Engineer'sDegree,Eng.

MasterinCityPlanning,M.C.P.

MasterofArchitecture,M.Arch.

MasterofBusinessAdministration,M.B.A.

MasterofEngineering,M.Eng.

MasterofFinance,M.Fin.

MasterofScience,S.M.

Other

Pleaseexplain.

IfSloanMBA,areyouintheEntrepreneurandInnovationtrack? Yes

No

Undecided

WhatwillbeyourfieldofstudyatMITnextacademicyear? AeronauticsandAstronautics

AerospaceEngineering

AerospaceEngineeringwithInformationTechnology

AfricanandAfricanDiasporaStudies

AmericanStudies

AncientandMedievalStudies

Anthropology

AppliedOceanScienceandEngineering

ArchaeologyandMaterials

Architecture

...92additionalchoiceshidden...

Science,Technology,andSociety

ShipbuildingandShipbuildingManagement

TechnologyandPolicyProgram

TheaterArts

Toxicology

Transportation

UrbanStudiesandPlanning

Women'sandGenderStudies

WritingandHumanisticStudies

Other

Pleaseexplain.

Anticipatedgraduationdatefromtheprograminwhichyouwillbeenrollednextacademicyear____/__/__(YYYY/MM/DD)

Areyouadualdegreeapplicant? Yes

No

ForDual-DegreeApplicants

InwhichMITschoolareyouenrolled/acceptedforyourseconddegree? MITSloan-HarvardKennedySchool

MIT-WellesleyCollege

MIT-WHOIJointPrograminOceanographyandAppliedOceanScienceandEngineering

SchoolofArchitectureandPlanning

SchoolofEngineering

SchoolofHumanities/ArtsandSocialSciences

SchoolofScience

SloanSchoolofManagement

Other

Pleaseexplain.

Whatisthedegreeprogramforyourseconddegree? BachelorofScience,S.B.

DoctorofPhilosophy,Ph.D.

DoctorofScience,Sc.D.

Engineer'sDegree,Eng.

MasterinCityPlanning,M.C.P.

MasterofArchitecture,M.Arch.

MasterofBusinessAdministration,M.B.A.

MasterofEngineering,M.Eng.

MasterofFinance,M.Fin.

MasterofScience,S.M.

Other

Pleaseexplain.

Whatisthefieldofstudyforyourseconddegree? AeronauticsandAstronautics

AerospaceEngineering

AerospaceEngineeringwithInformationTechnology

AfricanandAfricanDiasporaStudies

AmericanStudies

AncientandMedievalStudies

Anthropology

AppliedOceanScienceandEngineering

ArchaeologyandMaterials

Architecture

...92additionalchoiceshidden...

Science,Technology,andSociety

ShipbuildingandShipbuildingManagement

TechnologyandPolicyProgram

TheaterArts

Toxicology

Transportation

UrbanStudiesandPlanning

Women'sandGenderStudies

WritingandHumanisticStudies

Other

Pleaseexplain.

Anticipatedgraduationdateofseconddegree____/__/__(YYYY/MM/DD)

Tellusaboutyou!

Whatareyourstrongestpersonal/professionalattributesasanentrepreneurialleader(e.g.,deeptechnicalknowledge,regional“ontheground”knowledgeandconnections,leadershipcapabilities,etc.)?Providespecificexamplesofentrepreneurialprojectsorteamsthatyouhaveled.(Limit1000Characters)

Howcertainareyouthatyouwanttobeanentrepreneurinthedevelopingworldpost-graduation?(It’sokaytobeonthefence!)Whatareyourgreatestfearsorconcernsaboutpursuingthisentrepreneurialpath–andhowcanwehelpyoumakeupyourmind?(Limit1000Characters)

Whyareyoupassionateaboutthisventure,andhowhaveyourexperiences(educational,leadership,professional,etc.)preparedyoutopursueit?(Limit1000Characters)

Haveyoulivedinorvisitedthecountryinwhichyouintendtolaunchorscaleyourventure?Ifso,forhowlongandinwhatcapacity(e.g.,residentofthecountry,studiedthere,workedthere,etc.)?Howhasthisexperiencebeenrelevanttoyourventure?(Limit1000Characters)

Howdoyouplantousethisfellowshiptogrowasanentrepreneurialleaderandprepareyoutoworkfull-timeasadevelopingworldentrepreneuraftergraduation?(Limit1000Characters)

HaveyoutakenanyMITcourses(includingonlineeducationcourses–MITx)thathavebeenrelevanttothedevelopmentofyourventure? Yes

No

Pleaseselectallthatapply 15.910InnovationStrategy

15.911BEntrepreneurialStrategy

15.232H1EffectiveBusinessModelsinFrontierMarkets

2.739/15.783/ESD.32ProductDesignandDevelopment

15.385SocialInnovationandEntrepreneurship

2.888ProfessionalSeminarinGlobalManufacturingInnovationandEntrepreneurship

15.364RegionalEntrepreneurshipAccelerationLab(REAL)

15.779(formerly15.S14)Technology,Design,andEntrepreneurship:OperatinginEmergingCommunities

15375/EC.731/MA5.665DevelopmentVentures

15.128/20.454RevolutionaryVentures:HowtoInventandDeployTransformativeTechnologies

15.359InnovationEngineering:MovingIdeastoImpact

15.360IntroductiontoTechnologicalEntrepreneurship

15.378BuildinganEntrepreneurialVenture:AdvancedToolsandTechniques

15.390NewEnterprises

15.395EntrepreneurshipwithoutBorders

15.399EntrepreneurshipLab

15.785DigitalProductManagement

15.S68SSIM:OpportunitiesinDevelopingEconomies

10.807/15.371InnovationTeams

6.933EntrepreneurshipinEngineering:TheFounder’sJourney

Pleaselistanyadditionalcourses(includingMITx)thatarerelevant

Tellusaboutyouridea!NameofBusiness/Idea

CountryofImplementation

GeographicRegion

BusinessModel For-Profit

Non-Profit

Hybrid:For-Profit&Non-Profit

Undecided

Industry/Sector Agriculture

Apparel&Accessories

Automotive

Chemicals

ConsumerGoods

Education

Energy/Utilities

Food&Beverage

FinancialServices

Heathcare/Pharma

IT/Telecom

Law/LegalServices

Manufacturing

Media

ProfessionalServices

RealEstate

Retail&Wholesale

Transportation

Tourism&Entertainment

YourBusiness'sWebsite

YourBusiness'sTwitterHandle

YourBusiness'sFacebookPage

Pleaseprovideabriefdescriptionofyourventure.(Limit1000Characters)

Thefollowing6questionsaretohelpusassessyourstageofdevelopment.Wedonotexpectthatyouwillrateyourventurea4or5inallcategories.Wearemostinterestedinunderstandingthecurrentstageofyourventure,andwhatyourplansaretoleveragethefellowshipandyourtimeatMITinordertoprepareyoutoscaletheventurepost-graduation.

Onascaleofonetofivedescribethestageofyourventureintermsofthefollowing:Generalstageofdevelopment 1(e.g.,Idea/Exploration)

2

3(e.g.,ProofofConcept)

4

5(e.g.,InOperationwithpayingcustomers)

Onascaleofonetofivedescribethestageofyourventureintermsofthefollowing:PrimaryMarketResearch(PMR)/CustomerDevelopment 1(e.g.,NoPMR)

2

3(e.g.,PreliminaryPMR)

4

5(e.g.,PayingCustomer)

Onascaleofonetofivedescribethestageofyourventureintermsofthefollowing:Product/ServiceDevelopment

1(e.g.,StillintheLab/Testing)

2

3(e.g.,Prototype/Pilot)

4

5(e.g.,Manufacturing/ServicingatScale)

Onascaleofonetofivedescribethestageofyourventureintermsofthefollowing:Team 1(e.g.,JustMe)

2

3(e.g.,2-5FoundingTeamMembers)

4

5(e.g.,+5TeamMembers)

Onascaleofonetofivedescribethestageofyourventureintermsofthefollowing:Board

1(e.g.,NoBoard)

2

3(e.g.,BuildingaBoard)

4

5(e.g.,Board)

Onascaleofonetofivedescribethestageofyourventureintermsofthefollowing:FundingRaised

1(e.g.,NoFunding)

2

3(e.g.,Grants/Family&Friends)

4

5(e.g.,Angel/Venture)

Whatistheproblemyouaretryingtosolveandforwhosebenefit?(Limit1000charactersforeachsection)

Definetheproblemandcurrent/potentialimpactofyourideainthedevelopingworld.Pleaseincluderelevantdataandresearch(primaryorsecondary)youhaveidentifiedtosupportthisproblemstatement.

Whoareyourcustomersandwhatisthemarketpotential?Pleaseincluderelevantdataandresearch(primaryorsecondary)youhaveidentifiedtosupporttheaddressablemarketsize.

Whatassumptionshaveyoutestedtodatethatsupportthisproblemstatementandtheopportunityforimpact?Whatassumptionsdoyouplantotestduringthefellowshiptobetterunderstandthisproblem?

Whatisyourproposedproductorservice(inotherwords,yoursolution)?(Limit1000charactersforeachsection)

Describetheproposedproductorservice.

Whatprogresshaveyoumadeontheproductorservicetodate?Whatdoyouplantododuringthefellowshiptoadvanceyourproductorservice?

Whatisyourcompetitiveadvantage?(Limit1000charactersforeachsection)

Whoareyourprimarycompetitors?

Whydoyoubelieveyourproductorservicewillbeabettersolutionthanyourcompetitors’,andhowdoyouplantotestyourassumptions?

Whatisyourproposedbusinessmodel?Howdoyouexpecttomakemoney?(Limit1000Characters)

WheredoyouwantyourventuretobebyJune2019?Whatisyourvisionforhowyouwillgrow,launch,andpotentiallyscaleyourventurebetweennowandthen?(Limit1000Characters)

Whatarethetopchallengesorrisksyouseeasyougrow/scaleyourventure?Includeyourplanforhowtoaddresstheserisks.(Limit1000Characters)

Tellusaboutyourcurrentteam,includingabriefdescriptionof:(Limit1000charactersforeachsection)

Yourroleontheteam

Teammembers,includingnumberofcoremembers,theirroles,andrelevantexperience

Thekeyskillsyouneedtoaddtoyourteam

Tellusaboutyourfundingstatus,including:(Limit1000charactersforeachsection)

Thefundinghaveyouraisedtodate

Thefundingyouanticipateyouwillneedinthenext12monthstoreachthelevelofgrowthyoudescribedabove

Thefundingsources/platformsyouhaveutilizedtodate(e.g.,personalsavings/debt,grants,competitions,friendsandfamily,angel/venture,other)

HowdoyouenvisioncontributingasanindividualandthroughyourventuretotheLegatumCenterMission?(Limit1000Characters)

FINANCIALRESOURCES

Whatisthetotalestimatedcost(inUSD)ofyourMITprogramforthe2018-2019academicyear?Tuition,booksandsupplies,housing,etc.

Doyouhaveadditionalfellowships,scholarships,sponsorships,orotherfinancialsupport(includingpersonalandfamilyfunds)thatyouanticipateusingtosupportyourstudiesatMIT?TheLegatumCenterencouragesyoutoapplyforadditionalfinancialsupportsothattheCentercanmakeitsresourcesavailabletootherworthycandidatesaswell. Yes

No

Source1:Pleaseincludethenameofthesourceandtheamount.SourceName

Amount(inUSD)

Confirmed? Yes

No

Doyouhaveadditionalresources? Yes

No

Source2:Pleaseincludethenameofthesourceandtheamount.SourceName

Amount(inUSD)

Confirmed? Yes

No

Doyouhaveadditionalresources? Yes

No

Source3:Pleaseincludethenameofthesourceandtheamount.SourceName

Amount(inUSD)

Confirmed? Yes

No

Doyouhaveadditionalresources? Yes

No

Source4:Pleaseincludethenameofthesourceandtheamount.SourceName

Amount(inUSD)

Confirmed? Yes

No

Doyouhaveadditionalresources? Yes

No

Doyouhavemorethanfoursources? Yes

No

Howmuchfinancialsupport(inUSD)areyouseekingfromtheLegatumFellowship?

Areyou(planning)ontakingoutloansnextacademicyear?Ifyes,howmuch?

Pleaseprovideatleast3professionalreferences.Pleasenote,wewouldonlycontactthesereferencesifyoumadeittotheinterviewstageandwithyourpermission.

Reference1FirstName

LastName

Title/Company

Emailaddress

Phonenumber

Relationshiptoapplicant

Reference2FirstName

LastName

Title/Company

Emailaddress

Phonenumber

Relationshiptoapplicant

Reference3FirstName

LastName

Title/Company

Emailaddress

Phonenumber

Relationshiptoapplicant

Reference4(optional)

FirstName

LastName

Title/Company

Emailaddress

Phonenumber

Relationshiptoapplicant

AdditionalQuestions

DoyouknowaLegatumFellow? Yes

No

Whatishisorhername?

HowdidyouhearabouttheLegatumFellowship?(Checkallthatapply)

LegatumCenter's LegatumEvent(Pleasestatethetopicorspeaker)______________________

ConferenceatMIT(Pleaseindicateyear)______________________

Email(Pleasespecifysender)______________________

Website

LegatumCenterEntrepreneur-in-Residence

Other,pleasespecify...______________________

Websites MITSloanSchoolofManagement

MartinTrustCenterforMITEntrepreneurship

MITOfficeofGraduateAdmissions-GeneralSite

Other(Pleasespecify)______________________

SocialMedia/Advertisement(Pleasespecifypagesourceorlocation) Facebook______________________

Twitter______________________

LinkedIn______________________

Article,Flyer,Radio______________________

Other______________________

DirectContact(Pleasespecifywho) LegatumFellow/Alumni______________________

MITFaculty/Staff______________________

MITStudentorAlumni______________________

MITOrganizationorClub______________________

Non-MITContact______________________

OtherContact(Pleasespecifyeventlocationanddate) InformationSessionat______________________

Career/RecruitingFairat______________________

Conferenceat______________________

Other______________________

Wouldyouliketoopt-intotheLegatumCentermailinglist? Yes

No

Bysigningbelow,IcertifytheinformationIhaveprovidedtobeaccurate.