INSEAD GLOBAL EXECUTIVE MBA (GEMBA) INNOVATION SCHOLARSHIP Please enter your full name and admission class: Scholarship form guidelines: Step 1: Please read the scholarship description and topic essay on page 2 Step 2: Please write your essay on page 3 Step 3: Please fill in the financial profile form on page 4/5 Step 4: Please save your document under your name and e-mail it to: EMBA.ScholarshipCommittee@insead.edu 1 INSEAD GLOBAL EXECUTIVE MBA (GEMBA) SCHOLARSHIP FOR INNOVATION Description: Innovation creates new knowledge and technology that is central to value creation. INSEAD’s mission and values include understanding, recognizing and developing innovation, through teaching and research. The scholarship which will cover a portion of the tuition costs will be awarded based on merit and need to candidates accepted to the INSEAD GEMBA programme. Eligibility: Participants need to be self-funded or partially sponsored to a maximum of 50%. Scholarship Amount: The awards range between 5% and 20% of tuition fees, and are deducted from 3rd instalment. They can’t be used against the 15% deposit which must be paid in full. Essay topic: Please address the following questions (500 words): Describe an innovative idea that you have introduced within your company or organization. What was its impact? Explain why you are a good candidate for the INSEAD GEMBA Innovation Scholarship. 2 3 FIN ANCI AL INFO RMATIO N FORM PERSONAL INFORMATION Last Name: First Name: Nationality: Male: ☐ Age: Female: ☐ Current address: City: Country: Email: Postal Code: Tel: EMPLOYMENT INFORMATION Company: Place of work: Job Title: Current net annual salary (in Euros): Annual bonus if applicable (in Euros): Previous net annual salary (in Euros) for year 2013: 2012: 2011: ADMISSION INFORMATION Admission class: Admission date: Choose an item. Click here to enter a date. Scholarship applied for: Choose an item. FINANCIAL ASSISTANCE (IN EUROS) Have you applied for a bank loan to study at INSEAD? (If yes, which organisation and what amount?) Have you applied for scholarships or awards outside of INSEAD (If yes, please give details of scholarship names, award amounts and outcome dates) Will your company pay some of your tuition fees, if so how much? FINANCIAL ASSETS (IN EUROS) What is the value of your cash savings? What is the value of your real estate or business estate? What is your equity part? What is the value of your car? What is the value of your stocks, bond certificates or deposits? What is the value of trust funds you or your partner may be the beneficiary of? Any other assets not reported on this form? 4 FINANCIAL PLANNING (IN EUROS) In approximately 200 words provide a concise but accurate description of your financial circumstances. How do you expect to finance the studies if you do not receive a scholarship? What amount do you consider appropriate? FAMILY INFORMATION How many dependents do you have? What is your partner's occupation (if applicable)?) What is your partner's current annual salary (in Euros)? STATEMENT OF INTEGRITY I hereby certify that I have provided accurate information in this scholarship application. I authorize INSEAD to verify this information. I understand that any misrepresentation or omission of facts in this application may justify cancellation of admission or withdrawal from the INSEAD EMBA programme. This is my honest statement to INSEAD. I accept the Statement of Integrity: YES ☐ Date: Click here to enter a date. 5