27th Oct – 1st Nov, 2010 |Dhulikhel

Note: The hard copies of this form are also available at Samriddhi office. Please fill up all the answers and send it to
application@samriddhi.org or drop it at Samriddhi office, Kathmandu. The deadline for the form submission is
Monday 27th September, 2010.

Find detailed contact information at the bottom of this form.

Note: Please fill the form thoroughly, as it is the main basis for participant’s selection. Feel free to add paper or use
more space if you require.

Full Name
(Block Letters)

Age Gender
Contact No.
Mobile
Landline
Address

E-mail address

College/ University
Level
Year/Semester
(Bachelor
Faculty/Program (e.g. 2nd yr. or
s/
7th Sem. )
Master)
Do you think you can start up your own business? If yes, what is the business you would like to start and
If no, why do you think you can’t start a business?

Share any one incident where you displayed some leadership traits. This could be from your personal,
social or professional lives.

How did you first hear about arthālaya?( Please specify the source in detail)

What would you like to gain from arthālaya?

What extracurricular activities are you involved in? Also, mention your involvement in the student council
or clubs within your institution if any.

Have you attended any workshops, seminars before? If yes, Please specify the details.

Are you involved/working in any other organization? If ‘Yes’ please mention which organization and your
work there.

Please provide two references: (Preferably your teachers or college personnel)

Application Deadline: 27th September 2010, Monday S

For further information

Samriddhi, The Prosperity Foundation

P O Box: 8973 NPC 678 | 416, Bhimsengola Marga, Minbhawan Kharibot, Kathmandu.
Web: www.samriddhi.org | Email: info@samriddhi.org
Phone: (01) 4464-616, 4484-016 Fax: (01) 4485-319

Location map for the office is available at: http://www.samriddhi.org/page.php?id=3