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WHITE HOUSE FELLOWSHIP


APPLICATION


INSTRUCTIONS 

• Type all responses. Answer all questions fully and 

accurately. Sign and date the application at both 

Question 3 and Question 4. 

• Questions 6-15 should be answered on separate sheets 

of plain 8-1/2 x 11 paper. Each sheet should include 

your name and the question number in the upper right 

corner. 

• Do not return pages 4 and 5 of the application. Return 

only pages 2 and 3, your typed answers to Questions 

6-15, and your sealed recommendation letters. 

• 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 and will not be returned. 

• Do not put your application into a binder, staple, or 

package it in any elaborate way. Use one binder clip to 

hold the pages together. 

• Applications must be postmarked by February 1. 

It is the applicant’s responsibility to ensure their 

application is received by the Program Office. 

• 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 

c/o O.P.M. - Sheila Coates 

1900 E Street, NW, Room B431 

Washington, D.C. 20415 

Phone for express mail: (202) 606-1818 

PRIOR to sending their application, applicants are 

strongly encouraged to check our web site, 

www.whitehouse.gov/fellows, or call our office at 

(202)395-4522 for updated mailing instructions. 

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 email when their application has been received. 

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. Selection is based on qualifications and 

performance regardless of race, color, creed, religion, sex, 

age, national origin, sexual orientation, or disability. 

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P A R T I


1. PERSONAL DATA 

NAME (LAST, FIRST, MIDDLE) 

PREFERRED NAME 

Do you hold any 

Are you a U.S. citizen? non-U.S. citizenships? 

■ Yes ■ No ■ Yes ■ No 

BIRTHDATE (MONTH/DAY/YEAR) 

SOCIAL SECURITY NUMBER 

HOMETOWN (E.G., WHERE YOU GREW UP) 

OCCUPATION/PROFESSION 

Contact Information (where you can be reached from February 

to June): 

MAILING ADDRESS 

HOME PHONE WORK PHONE 

FAX NUMBER E-MAIL ADDRESS 

Employment Information: 

CURRENT EMPLOYER’S NAME 

CURRENT EMPLOYER’S ADDRESS 

CURRENT EMPLOYER’S TELEPHONE NUMBER 

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:


How did you hear about the White House Fellows Program?


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


Have you ever been accused of any misconduct?


■ Yes ■ No


Is there anything in your background that could preclude you


from obtaining a security clearance?


■ Yes ■ No


3. CERTIFICATION 

I certify that all information in my application is my own work 

and that all of the statements are factually true, complete, and 

honestly presented. 

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 

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5. REFERENCES 

In the space below, list the names and contact information for 

the individuals whose personal evaluations accompany this 

application (see page 6). 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 

It is the responsibility of the applicant to ensure recommendations accompany the application. 

#4 

NAME 

ADDRESS 

ADDRESS 

CITY, STATE, ZIP 

#5 

NAME 

ADDRESS 

ADDRESS 

CITY, STATE, ZIP 

Please indicate whether any of the references above are 

alumni, regional panelists, or commissioners. 

■ Yes ■ No 

If yes, please list name of reference: 

Have you been a Regional or National Finalist before? 

■ Yes ■ No 

If yes, please list years and regional panel assignments: 

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P A R T II


INSTRUCTIONS 


FOR QUESTIONS 6-15


The following questions should be answered on separate sheets 

of paper. Type your name and question number in the upper 

right corner of each page. Do not return or reproduce the 

questions with your application; submit only the answers. 

6. 	PROFESSIONAL AND EDUCATIONAL 

COMBINED SUMMARY 

On a separate sheet of paper, under the heading 

“Professional/Educational Summary, “ please provide a chronological listing of every position 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 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 

7. 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 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. 

8. PROFESSIONAL EXPERIENCE 

On a separate sheet of paper type the heading “Professional


Experience” and provide details about your employment


history. Begin with 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. Employer’s contact information not necessary 


for jobs held over seven (7) years ago. 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 also describe previous work accomplishments,


but do not exceed 100 words for each description.


9. 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 


10. 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


4

■

■

■

INSTRUCTIONS 


FOR QUESTIONS 11-15


Follow instructions for Questions 6-10 regarding page 

format. You will be judged on the clarity and quality of your 

writing, as well as the substance of your narratives. 

11. 	MOST SIGNIFICANT 

PROFESSIONAL ACHIEVEMENT 

On a separate sheet of paper, type the heading “Professional 

Achievement” and describe what you consider to be your 

most significant contribution within your professional field. 

Please limit your narrative to 200 words. 

12. 	MOST SIGNIFICANT COMMUNITY 

SERVICE CONTRIBUTION 

On a separate sheet of paper, type the heading “Community 

Service Contribution” and describe what you consider to be 

your most significant contribution to your community. 

Please limit your narrative to 200 words. 

13. 	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. 

14. 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, and what position you hope to attain. 

Please limit your narrative to 300 words. 

15. 	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. 

16. 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 your recommenders 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 with your application by the deadline. Your 

application will not be considered without these references. 

APPLICATION CHECKLIST 

■	 Question 3 and Question 4 signed 

in ink and dated 

■ One original and two copies of application 

■ Sealed, signed recommendations 

FOR MORE INFORMATION 

THE PRESIDENT’S COMMISSION 

ON WHITE HOUSE FELLOWSHIPS 

c/o O.P.M. - Sheila Coates 

1900 E Street, NW, Room B431 

Washington, D.C. 20415 

202-395-4522 (phone) 

202-395-6179 (fax) 

www.whitehouse.gov/fellows 

Please check web site for updated mailing instructions. 

P A R T III


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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 Please answer the following questions (on your office letter-


the White House Fellowship applicant named above. Your head, if appropriate) and include your daytime telephone


candid and specific responses to the questions below will help number. Please sign and date your evaluation, place it in a


the President’s Commission select the next class of White sealed envelope, sign your name over the seal, and return the


House Fellows, 11 to 19 individuals from across the Nation envelope to the applicant. The applicant must submit your


who will come to Washington to work for one year as paid, evaluation as part of his or her application. The application


full-time special assistants to Cabinet officers and senior White deadline is February 1.


House officials.


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

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

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

ability? 

2. What are the applicant’s major strengths? Please relate an 

occasion in which these strengths were demonstrated.	 9. How would you describe this candidate’s public speaking 

ability? 

3. What are the applicant’s major weaknesses? 10. How would you describe this candidate’s personal integrity? 

4. What impact has the applicant had within his/her professional field?	 11. How would you describe this candidate’s consensusbuilding, negotiating and leadership skills? 

5. What impact has he/she had in the community, outside of 

the applicant’s professional realm? 12. If you were a Cabinet Secretary, would you hire this person 

to be a key member of your staff? 

6. What has the candidate done that you consider creative? 13. What do you expect this candidate to be doing in 

15 to 20 years? 

REPRODUCE THIS FORM FOR REFERENCES 

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THE PRESIDENT’S COMMISSION 

ON WHITE HOUSE FELLOWSHIPS 

c/o O.P.M. - Sheila Coates 

1900 E Street, NW, Room B431 

Washington, D.C. 20415 

202-395-4522 (phone) 

202-395-6179 (fax) 

www.whitehouse.gov/fellows 
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 fifteen (15) to twenty-five (25) 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