White House Fellowship Application

Instructions

Type all responses.  Answer all questions fully and accurately.  Sign and date the application at both Q.3 and Q.4. 

Be sure to carefully follow the directions for Q.6: it is your receipt.

The remaining questions should be answered on separate sheets of plain, white, 8-1/2 x 11 paper.  Each sheet should include your name, Social Security number, and the question number in the upper right corner.

Do not include additional items (such as books you have written or music you have recorded) with your application.  Supplementary material will not be reviewed if sent.

Do not put your application into a binder or package it in any elaborate way.  Use a paper clip or binder clip to hold the pages together.  

Applications must be postmarked by February 1.  Applications mailed from overseas should be sent by air mail or other timely means as early as possible.

Mail one original and two copies of your application to:

The President’s Commission on White House Fellowships
712 Jackson Place, NW
Washington, DC 20503

This application may be downloaded directly from the Internet, but it may not be submitted in electronic form.  Only hard-copy paper applications, one of which must include original signatures, will be accepted.

Applicants will be notified by mail that their application has been received.  See Q.6.

Only U.S. citizens are eligible to apply.  Civilian employees of the federal government are not eligible.  The Commission cannot consider applications from ineligible applicants, nor grant exemptions from these requirements.

The federal government is an equal opportunity employer.  Hiring is based on qualifications and performance regardless of race color, creed, religion, sex, age, national origin, sexual orientation or disability.

Part I

1.  PERSONAL DATA

_______________________________________________Name (Last, First, Middle)

_______________________________________________Other names used
Are you a U.S. citizen?  [   ] Yes   [   ]  No
_______________________________________________
Birthdate (month/day/year)

_______________________________________________
Social Security Number

_______________________________________________
Occupation/Profession

Contact Information (where you can be reached from February to June):

_______________________________________________
Mailing Address:  Street

_______________________________________________
City, State, Zip

_______________________________________________
Home Phone			Work Phone

_______________________________________________
Fax Number			E-mail Address

Employment Information: 

_______________________________________________
Current Employer’s Name

_______________________________________________
Current Employer’s Address:  Street

_______________________________________________
City, State, Zip

_______________________________________________
Your Title, Rank or Status

Have you ever worked for or are you now working for the federal government, or are you being paid by federal funds?  (Include active duty military service.)  
[    ]  Yes	[    ]  No

If YES, please explain below and give inclusive dates:
_______________________________________________
_______________________________________________
_______________________________________________

2.  Personal Declarations
Please answer the following questions and explain on a separate sheet of paper details and resolution of any question answered “yes.”
Have you ever been discharged from the Armed Forces under other than honorable conditions?
[    ]   Yes	[    ]  No
Have you ever been convicted of a criminal offense?
[    ]   Yes	[    ]  No
Have you ever been charged with a felony?
[    ]   Yes	[    ]  No
Have you ever been charged with a violation of any firearms or explosives laws?
[    ]   Yes	[    ]  No
Have you ever failed to meet a court-ordered child support payment?
[    ]   Yes	[    ]  No
Are you delinquent on any federal debt?
[    ]   Yes	[    ]  No
Have you ever been suspended, disciplined, or barred from any occupation or practice by any regulatory agency, professional association or organization because of your conduct?
[    ]   Yes	[    ]  No

3.  Certification
I certify that all of the statements in this application are true, complete, and correct to the best of my knowledge and belief, and are made in good faith.
______________________________________________
Signature (in ink)			Date

4.  Investigation
I know and understand that any or all items contained herein may be reviewed by representatives of the Commission, including former White House Fellows, and if I become a National Finalist, are subject to investigation or verification by duly accredited investigators of the federal government.
______________________________________________
Signature (in ink)			Date

5.  References

In the space below, list the names and contact information for the individuals whose personal evaluations accompany this application (see Q.17).  You may submit a minimum of 3 and a maximum of 5 recommendations for consideration.

#1

______________________________________________
Name

______________________________________________
Address

______________________________________________
Address

______________________________________________
City, State, Zip

#2

______________________________________________
Name

______________________________________________
Address

______________________________________________
Address

______________________________________________
City, State, Zip

#3

______________________________________________
Name

______________________________________________
Address

______________________________________________
Address

______________________________________________
City, State, Zip

#4

______________________________________________
Name

______________________________________________
Address

______________________________________________
Address

______________________________________________
City, State, Zip

#5

______________________________________________
Name

______________________________________________
Address

______________________________________________
Address

______________________________________________
City, State, Zip

Part II

6.  Required Cards

The following two cards must be included with your application:

(1)  A typed 3 x 5 index card that lists on one side only your name, mailing address, home and work phone numbers, and date of birth. 

(2)  A self-addressed, stamped postcard.  This card will be mailed to you as a record that your application has been received by the Commission.

PART III

INSTRUCTIONS FOR QUESTIONS 7-16

The following questions should be answered on separate sheets of paper.  Type your name, Social Security Number and question number in the upper right corner of each page.  Do not return or reproduce the questions with your application; submit on the answers.

7.  Career Summary

On a separate sheet of paper, under the heading “Career Summary, “ please provide a chronological listing of all the positions you have held, beginning with the most recent.  Include dates, employers and/or schools attended.  Account for all periods of unemployment.  Please limit your response to a maximum of one page; details can be furnished in response to later questions.

Example:
11/98 to present	Senior VP, Acme, Inc.
9/96 to 11/98		Sales Director, Acme, Inc.
6/96 to 9/96		Unemployed/Job Search
8/94 to 6/96		MBA student, Big Univ.
6/94 to 8/94		Service Project in Peru
9/90 to 6/94		Student, Small College

8.  Educational Background

On a separate sheet of paper, type the heading “Educational Background” and include the following information:

(1) Under the heading “School Attended” list all schools attended including high school with degree or diploma earned, name of school, location, and dates attended.

(2)  Under the heading “Activities” list all of the major extracurricular activities in which you participated.  Briefly explain each one and list the level of your participation, including any offices held, and the length of your membership.  List major awards or recognitions received.

9.  Work Experience

On a separate sheet of paper type the heading “Work Experience” and provide details about your employment history.  Work back from your current position and account for all periods of employment and unemployment.  Do not substitute a resume.  You may use as many sheets of paper as required.  Use the following as a guide:

Dates of employment
Exact job title
Employer
Employer’s address and phone number
Nature of the business
Number of workers you supervised

For your current position please provide a brief narrative descriptive of the work you performed, not to exceed 200 words. You may at your option describe previous work accomplishments but do not exceed 100 words for each description.

10.  Voluntary Activities

On a separate sheet of paper, type the heading “Voluntary Activities” and list the major civic and social activities (not related to your job) in which you have participated.  Use the following as a guide:

Name of organization
City and State
Purpose or objective of the organization
Size of organization
Your level of participation
Dates of your participation
Awards or recognitions you received 

11.  Professional Activities

On a separate sheet of paper, type the heading “Professional Activities” and list the major business and professional activities in which you have participated. Use the following as a guide:

Name of organization
City and State
Purpose or objective of the organization
Size of organization
Your level of participation
Dates of your participation
Awards or recognitions you received

INSTRUCTIONS FOR QUESTIONS 12-16

Please be aware that you will be judged on the clarity of your writing and your ability to follow instructions as well as on the substance of your narratives.  

12.  Most Significant Achievement: 
       Professional

On a separate sheet of paper, type the heading “Professional Achievement” and then describe what you consider to be your most significant contribution to your professional field.  Please limit your narrative to 200 words.

13.  Most Significant Achievement:
       Community Service

On a separate sheet of paper, type the heading “Community Service Achievement” and then describe what you consider to be your most significant contribution to your community.  Please limit your narrative to 200 words.

14.  Memorandum for the President

On a separate sheet of paper, type the heading “Memorandum for the President” and write a memorandum for the President making a specific policy proposal.  Explain why you think it is important, what issues it raises, and why you think the President should support your proposal.  Please limit your memo to 500 words.

15.  Lifetime Goals

On a separate sheet of paper, type the heading “Lifetime Goals” and describe your life’s ambition, what you hope to accomplish or achieve in your lifetime, and what position you hope to attain.  Please limit your narrative to 300 words.

16.  Why I Want to Be a White House Fellow

On a separate sheet of paper, type the heading “Why I Want to Be a White House Fellow” and describe your motivation for applying for this fellowship, what you consider to be your major strengths and qualifications for the program, and what benefits you feel are likely to result from your participation.  Please limit your narrative to 300 words.
PART IV

17.  References

Please reproduce the Candidate Evaluation form that is part of this application and give it to a minimum of 3 and a maximum of 5 people who know you well.  Recommenders should have a direct knowledge of your qualifications and character.  

At least one of them should have professional competence in your field, at least one should have knowledge of your major community or civic activities, at least one should have knowledge of your business or professional accomplishments, and at least one should be your current supervisor, if applicable.  

Each of your recommenders should seal the letter of reference in an envelope, sign his or her name across the seal, and return the sealed, signed letter to you.  These references must be submitted along with your application by the deadline.  Your application cannot be considered without these references.

APPLICATION CHECKLIST

[    ]  Q.3 and Q.4 signed in ink and dated

[    ]  One original and two copies of application

[    ]  Two cards as requested in Q.6

[    ]  Sealed, signed recommendations

For More Information

President’s Commission on White House Fellowships
712 Jackson Place, NW
Washington, DC 20503
202-395-4522
202-395-6179 (fax)
www.whitehouse.gov/WH_Fellows

REPRODUCE THIS FORM FOR REFERENCES

White House Fellowship Application
Candidate Evaluation

To:		___________________________________________________
		Individual completing evaluation

From:		The President’s Commission on White House Fellowships

Subject:	___________________________________________________
		Applicant’s name

Thank you for taking the time to write a recommendation for the White House Fellowship applicant named above.  Your candid and specific responses to the questions below will help the President’s Commission select the next class of White House Fellows, 11 to 19 individuals from across the nation who will come to Washington to work for one year as paid, full-time special assistants to Cabinet officers and senior White House officials.

1.  How long and in what connection have you known the applicant?

2.  What are the applicant’s major strengths?  Please relate an occasion in which these strengths were demonstrated.

3.  What are the applicant’s major weaknesses?

4.  What impact has the applicant had on his/her professional field?

5.  What impact has he/she had in the community, outside of the applicant’s professional realm?

6.  What has the candidate done that you consider creative?

Please answer the following questions (on your office letterhead, if appropriate) and include your daytime telephone number.  Please sign and date your evaluation, place it in a sealed envelope, write your signature over the seal, and return it to the applicant.  The applicant must submit your evaluation as part of his or her application.  The application deadline is February 1.

7.  How would you describe this candidate’s writing ability?

8.  How would you describe this candidate’s intellectual ability?

9.  How would you describe this candidate’s public speaking ability?

10.  How would you describe this candidate’s personal integrity?

11.  How would you describe this candidate’s consensus-building, negotiating and leadership skills?

12.  If you were a Cabinet Secretary, would you hire this person to be a key member of your staff?

13.  What do you expect this candidate to be doing in 15 to 20 years?

PRIVACY ACT

The President’s Commission on White House Fellowships operates its competitive application process and collects personal information for evaluating applications under authority of Executive Order 11183, as amended.   Submission of the information is voluntary; however, failure to furnish all the requested information may result in a delay or elimination from consideration for a fellowship.  Executive Order 9397 authorizes us to request your Social Security Number to identify individual records.  Furnishing your Social Security Number is voluntary and failure to provide it on this application will not affect the consideration of your application. The information you provide, or that is submitted on your behalf, may be disclosed to members of our selection committees, made up of former White House Fellows, individuals from the private sector or other governmental agencies.  The information may also be disclosed to a congressional office in response to an inquiry from that office made at your request.

PAPERWORK REDUCTION ACT

Under the Paperwork Reduction Act, no person may be required to respond to a collection of information unless it displays a valid OMB number (this form is designated with OMB Control No. 3200-0032).  This form is estimated to take an average of eight (8) hours to complete, including time for reviewing instructions, gathering the requested personal evaluations, and completing the application.  Please send comments regarding this burden estimate or any other aspect of this collection of information to the President’s Commission on White House Fellowships, Washington, DC.

RECORDS RETENTION

The application forms of persons selected as White House Fellows may be circulated to appropriate Executive Branch officials incident to placing Fellows in assignments for the fellowship year and subsequently may be retained, along with other applicant file materials, by the Commission in its permanent files on persons who are selected as White House Fellows.  These permanent records are accessible to the individuals concerned.  Sixty days after a letter has been mailed to an applicant advising that he or she has been eliminated from the competition, all materials in the applicant’s file will be destroyed and this procedure will be repeated after each stage of the selection process.  The Commission cannot be responsible for the return of applications or supporting documents. Applicants are therefore advised to retain copies of their application forms and not to submit irreplaceable documents or materials with applications.

OMB Control No. 3200-0032