PART 1: PERSONAL DATA
1. Name (first/middle/last):
2. Nick name or preferred name:
3. Address:
4. District:
5. Cell/Mobile No.:
6. Email:
7. Date of birth (Nepali/English):
8. Age on November 10, 2015:
9. Please list the people in your household (name/age/relationship):
10. How did you learn about the BMKF Scholarship Program?
11. a) Marks obtained in SLC and % in class:
b) Marks obtained Class XII/10+2 and % in class:
Affix recent passport size photograph
12. State your planned course of study (specific bachelor’s degree or certificate program):
13. Provide name and contact information for the university or institute where you plan to study:
Contact: Ms. Sabita Ghising, BMKF Program Coordinator (Kathmandu)
Email: ghising.sabu2@gmail.com | Mobil: + 9843930486 | www.bomkarlsson.org
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PART 2: PERSONAL NARRATIVE
Answer the following questions in the space provided or on a separate sheet of paper.
1. Describe your family background and circumstances, including your family income and where your parent(s) or husband work:
2. Describe your past educational experience. What difficulties did you experience? What successes? Who or what inspires you to continue your studies?
Contact: Ms. Sabita Ghising, BMKF Program Coordinator (Kathmandu)
Email: ghising.sabu2@gmail.com | Mobil: + 9843930486 | www.bomkarlsson.org
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3. Describe a typical day in your life. What do you do from morning to night? Do you have a job or other responsibilitie? How do you like to spend your time if you have a choice?
4. Describe your educational and career goals. Where do you see yourself in five years?
4. Describe your life as a woman in your local community or your country. How will you use your education to help improve the lives of other women in Nepal?
Contact: Ms. Sabita Ghising, BMKF Program Coordinator (Kathmandu)
Email: ghising.sabu2@gmail.com | Mobil: + 9843930486 | www.bomkarlsson.org
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PART 3. PERSONAL ESSAY TOPIC
Choose one of the essay topics below. On a separate sheet of paper, write a 1-2 page(s) essay.
Please provide detail. Your personal essay should be different from the other information you provided on the application form and describe your unique viewpoint and experience.

Describe a significant interest, achievement, or experience that has special meaning for you or influenced you in a positive way. How did it change your life or perspective?

What special attribute, quality, or skill distinguishes you from other people? How did you develop this attribute? What difference does it make?

Why have you chosen this academic focus and/or career path? What was your inspiration?
How will this career make a difference for you or for other people? Explain.
APPLICANT AGREEMENT
I understand that the Bo M. Karlsson Foundation will contact me and that BMKF may do a home visit to verify information in this application. By signing my name below, I give permission for a home visit and agree that the information provided in this application is true and accurate to the best of my knowledge. I understand my application does not guarantee a Bo M. Karlsson Foundation scholarship — and that scholarships may be awarded fully, partially, or not at all, depending on available funds and need. If I am selected as a BMKF Scholarship recipient, I agree to communicate with BMKF at least every three months, to provide an update on my schooling and experience.
NAME (print): __________________________________________________
SIGNATURE: ___________________________________________________
DATE: _________________________________________________________
Contact: Ms. Sabita Ghising, BMKF Program Coordinator (Kathmandu)
Email: ghising.sabu2@gmail.com | Mobil: + 9843930486 | www.bomkarlsson.org
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