KARMA KAGYU STIFTUNG Herbert Giller (Vorstand) Zum Buck 11 D-79809 Remetschwiel tel +49 (0)7755-939204 fax +49 (0)7755-939206
Please complete (add enclosures if any)
. NUMBER of ENCLOSURES:
Applicant 5
Name:....................................................................First name:............................................................... Date of birth:
Address:.......................................... ....................................................................................................... City:...................................................................... Country:................................................................... Zip-code/postal-code:........................................... Nationality:........................................................... Marital status:........................................................... Profession:............................................................ ................................................................................. College / University diploma:................................................................................................................. Fax / Phone / E-mail:..............................................................................................................................
Application 15
The applicant requests scholarship for the following purpose(s) (tick one or more, give a description of your project as enclosure , if the category is not mentioned hereafter ):
20
RETREAT: drubkhang trad. 3year drubkhang laycenter individual monastic activities active participation in a laycenter active participation in a monasticcenter STUDIES: at KIBI at another institute individual (to be specified) STUDIES of buddh. art tibetain language ritual procedures ACTIVITIES as a teacher at KIBI as teacher at other buddh. centers as teacher in the monasteries other purpose (to be specified) The project starts on
/
/
and ends
/
/
open-ended
Details of institute, university, retreat center etc. + phone email and fax:
25
30
Name:...................................................................................... E-mail:................................................... Address:....................................................................................Phone:................................................... City:.............................................................................................. Fax:................................................... Country:.................................................................................................................................................. Who will be your principal teacher :..................................................................................................... Your educational background, studies, retreats, etc.; please enclose supporting documents secondary school
35
college
university
threeyearretreat
from .............................to................................
other buddhist retreats
from .............................to................................
KIBI studies
from ............................ to ...............................
others
please specify :......................................................................................................................... from ............................ to ...............................
KKS APPLICATION
12/27/11 , 10:08:32 AM,
ver.12.2011
page
-1 -
Financial calculation: (as known on date of this application or as estimation, -all values in euro only -) This budget is calculated for a month>
40
for a year>
other period>........................................................
Already received regular income+donations from other sources for the applied purpose (i.e. received on private accounts or somewhere else):
Expected are promised grants by sponsors (total sum):.................................................................................... Sum of already received funds:.......................................................................................................................... Total cost of the entire project:...........................................................................................................................
45 The applicant is applying for financial support by KKS amounting to:_________________________________
Account details:(please ask your bank for their correct identification numbers and codes) Account name if different from applicant:......................................................................................... 50
Bank name::......................................................................... .................................................................. IBAN:.................................................................................. SWIFT-BIC:............................................. ask your bank for as many details as possible. Please attach a new RIB
Statement 55
I confirm that the above statements are true and correct, and that I accept the condition that any scholarship provided by the Foundation may ONLY be used for the abovementioned purposes. The applicant will provide evidence for his expenditures related to the applied purpose. Unused funds must be paid back to the Foundation. The Karma Kagyu Foundation is entitled to deduct 5% of specific funds for costs and fees.
65 don't fill in below____________________________________________________________________don't fill in below For internal administration only: client number-KDNR:
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