Please Note: This is a sample application for viewing purposes only. This application cycle is currently closed.

Registration Section
Personal Information
First Name (Legal):
Middle Name:
Last Name:
Preferred Name:
School email:
Home Address:
State: Zip:
Home Phone: ( ) -
Cell Phone: ( ) -
I identify my gender as:
School Information
School District: Please select the school district where you are currently employed.

  If other, please specify
Subject: Please select all that apply.
  • If CTE, please specify:
    If other, please specify:
    Grade: Please select all that apply.
  • School Address:
    State: Zip:
    Do you plan to work in this school district again next year?
    Phone: ( ) -
    Fax: ( ) -
    Application Section
    Educational Information
    Educational History: List all colleges or universities you have attended. Begin with the most recent.
    College/University Location Major Degree Start Date End Date
    Teaching Experience
    Areas of Certification:
    Years of teaching experience:
    National Board Certification Status:
    Teach for America (TFA):
    NC Teaching Fellows:
    Employment History: List your employment experience. Begin with your current position.
    Position/Title Employer Location Start Date End Date
    Other Information
    List all presentations made in the last 5 years at local, statewide and national conferences or workshops. Include the titles of presentations, and the names and dates of conferences. Enter most recent first:

    Audience Title of
    Name of Conference
    or Workshop/Article
    Date of

    List all grants that you have received in the last 5 years, include dates and the amount: Enter most recent first:

    Name of Grant Amount of Award ($) Date Awarded

    Provide specific examples of your role as a teacher leader and describe the impact on other teachers. Enter most recent first:

    Name of Role or Activity Realm of Influence Start Date End Date

    Do you teach at a Title 1 school?         I don't know

    How did you hear about the Kenan Fellows Program for Teacher Leadership?

    Please describe:
    Project Preferences
    All applications will be considered for every opportunity available within the defined ranges of the applicant's school district as listed on the current year's fellowship descriptions at
    I am interested in:
    (Check All That Apply)

    Experience: I have prior experience in the following

    Short Answer Questions
    Please answer the following questions in 100 words or less in the space provided.

    Where do you find or make community?

    What areas of expertise or special skills would you bring to the cohort?

    List two questions you would enjoy answering about yourself.

    Essay: The Kenan Fellows Program for Teacher Leadership seeks teachers to be part of a network of accomplished educators who model innovative and relevant instructional practices. Kenan Fellows work to build leadership and instructional skills and develop new resources based on unique summer internships. Please respond to the following three questions and use specific examples when possible.
    1. Why are you interested in becoming a Kenan Fellow?
    2. Describe your community/students/school. What does a typical instructional day in your class/job look like?
    3. What changes/additions/resources would you like to incorporate either personally or professionally?
    You may choose to submit your response in 1 of 2 ways. Please select one option.
    1. Write a brief essay of no more than 500 words that addresses the 3 questions listed above. Save the document as a PDF file and upload it to the application.
    2. Create a 3-5 minute video that addresses the 3 questions listed above. Please provide the URL for your video in the text box below. We strongly encourage you to upload your video as a Youtube link and to double check the link prior to submission to ensure its functionality.
    File Upload:
    File Upload
    (PDF format only)
    If you do not have a PDF conversion tool you can use one of these free on-line PDF converters: PDF Online - PDF Converter. To ensure that your files may be properly included in your application, please ensure that they are not protected via encryption, a password, a signed certificate or in any other manner.

    or Video URL:
    Letters of Recommendation
    Two letters of recommendation are required in support of your application. One must be from an administrator, and the other should be from an individual familiar with your work as an educator. Once you have submitted your application, we will email them instructions for submitting an online letter of recommendation on your behalf. Please inform your designees that they will receive an email with instructions from In addition, we may contact them by phone for additional information. These letters are due by Monday, February 20, 2023.

    Name Position Email Address Phone Number
    I understand, if I am selected, the Kenan Fellows Program requires a commitment of me including participation in three weeks of a summer internship, 9 days of attendance at three Professional Development Institute, and completion of a product to be disseminated to other educational professionals.

    Disclaimer: The Kenan Fellows Program is funded through gifts, contracts and grants. Consequently, Kenan Fellowships are contingent upon the continued availability of such funding. In the rare event that existing funding is terminated or continued funding is unavailable, Kenan Fellowships may be subject to early termination.

    If you have any questions about the application process you may reach the Kenan Fellows Program staff at (919) 515-5118 or email us at

    Please Note: This is a sample application for viewing purposes only. This application cycle is currently closed.