* 1. Name:

* 2. Address

* 3. Mobile

* 4. Tell us about your passion or dream and how receiving the kick-off award would help you achieve it (no more than 200 words):

* 5. Have you received financial assistance for this passion before? If so from whom and approximately how much?

* 6. Action plan: - Include dates by which you intend to achieve your goals.

* 7. List any relevant prizes, awards and/or scholarships you have received:

* 8. List any work experience that you have:

References - Please list two people who are available to provide a phone reference for you. There is no requirement for a written reference with your application.

* 9. Reference 1: Name, Position, Mobile

* 10. Reference 2: Name, Position, Mobile

* 11. Acknowledgement: - I certify that the information given in this application is complete and accurate, to the best of my knowledge. I consent to having the Power House Youth Leadership Foundation make my application and supporting materials available to the Selection Committee. If successful in receiving an award, I agree to adhere to my action plan detailed in the application and to comply with all conditions of the award.

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