Sponsor: Kenan Institute for Engineering Technology & Science
Program: Kenan Fellows Program for Teacher Leadership
|First Name (Legal):|
|Home Phone:||( ) -|
|Cell Phone:||( ) -|
|I identify my gender as:|
|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.
|Do you plan to work in this school district again next year?|
|Phone:||( ) -|
|Fax:||( ) -|
|Educational History:||List all colleges or universities you have attended. Begin with the most recent.|
|Areas of Certification:|
|Years of teaching experience:|
|National Board Certification Status:|
|Teach for America (TFA):|
|NC Teaching Fellows:|
List your employment experience. Begin with your current position.
|Name of Conference
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?
|I am interested in:
(Check All That Apply)
|Experience:||I have prior experience in the following
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.
|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 email@example.com.Please Note: This is a sample application for viewing purposes only. This application cycle is currently closed.