Passion For Potential

Passion for Potential
Scholarship Application

All information you provide is confidential and will be shared only with the Passion for Potential Scholarship Awards Committee.

Date of Application ________/________/________

Contact Information

Name _______________________________________________________
Street________________________________________________________
City/State/Zip__________________________________________________
Home Phone__________________________________________________
Work Phone___________________________________________________
Cell Phone ___________________________________________________
Email______________________@________________________________

Personal Information

Place of employment____________________________________________
Employed since:________/________/________
Currently teaching grades:_________
How many years have you been teaching?_________
Date of birth________/________/________
Are you single or married?__________________
If you are married, how does your spouse feel about the possibility of your experience with Passion for Potential? (please explain)
____________________________________________________________
____________________________________________________________
____________________________________________________________

If you have children, what are their ages?________________________
If you are accepted as a Teacher Participant, and your experiential education involves time away from your home and family, what arrangements will you make to care for you family in your absence?
____________________________________________________________
____________________________________________________________
____________________________________________________________

Tell Us About Yourself (Again, all answers are confidential)
What would you do if you are selected as a Passion for Potential teacher participant?
____________________________________________________________
____________________________________________________________
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Why did you become a teacher?
____________________________________________________________
____________________________________________________________
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What are the top challenges you face as a teacher today?
____________________________________________________________
____________________________________________________________
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If you are selected as a Passion for Potential scholarship recipient, how do you believe you can make a difference in your school after completing the program?
____________________________________________________________
____________________________________________________________
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Who is someone you made a difference in your life, and how?
____________________________________________________________
____________________________________________________________
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How do you hope to benefit from Passion for Potential?
____________________________________________________________
____________________________________________________________
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Do you participate in any experiential activities now?
Have you ever? Please explain
____________________________________________________________
____________________________________________________________
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What are some of your hobbies, interests, and why?
____________________________________________________________
____________________________________________________________
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Please list some primary interests you would pursue if you had support, designated time, and no other constraints?
____________________________________________________________
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Have you ever developed a project budget? Describe
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How would you feel if your dream isn’t fulfilled after completing the Passion for Potential program?
____________________________________________________________
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How do you think you handle conflict and/or defeat?
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References:
Name/Relationship/Contact Information of three PERSONAL references
____________________________________________________________
____________________________________________________________
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Name/Relationship/Contact Information of three PROFESSIONAL references
____________________________________________________________
____________________________________________________________
____________________________________________________________

Mail this application to:
Passion for Potential
6950 Peters Pike
Dayton OH 45414

www.passionforpotential.org

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