Apply for Scholarship Please fill out the form below to apply for the scholarship. Personal Information Full Name * Date of Birth * Gender * Male Female Prefer not to say Father’s/Guardian’s Name & Occupation * Mother’s Name & Occupation * Contact Number (with country code) * Email Address * Full Address (village/city, district, country) * Academic Information Current Grade/Class Level * Select Grade Grade 9 Grade 10 Grade 11 Grade 12 University – Year 1 University – Year 2 University – Year 3 University – Year 4 Name of Current School/College/University * Previous Exam Results (include GPA/Grades and year) * Upload Recent Transcript (PDF/JPG) * Browse or drag and drop file Teacher/Principal’s Recommendation Letter (optional) Browse or drag and drop file Financial & Family Information Family Income * Select Income Below $100/month $100–$200/month $200–$400/month Above $400/month Number of Family Members * Are you the first in your family to pursue this level of education? * Yes No Do you currently receive any other scholarship or financial aid? * Yes No Describe your financial challenges (100–200 words) * Essay / Motivation Why do you want this scholarship, and how will it impact your education? (200–300 words) * What are your future goals, and how will you use your education to help your community? (200–300 words) * Supporting Documents Upload a recent passport-size photo (JPG/PNG) * Browse or drag and drop file Upload academic certificates/marksheets (PDF/JPG) * Browse or drag and drop file Agreement & Consent I declare that the information provided is true and correct. I agree to share my academic and personal information with BreakOrDie Scholarship Committee for evaluation purposes. Submit Application
