Inspired by Principal Baruti Kafele, prestigious Milken National Educational Awardee who came to Durham in October 2012,
the Durham Black Educators’ Network established the Activating Student Success Awards. This annual event seeks to
recognize the outstanding leadership of students of the Black diaspora within Durham region.
This award will be given to six Durham District School Board students, grades 7 to 12. There will be two elementary students
and four high school students. Applications must be submitted by the last Thursday in March to the selection committee,
through the Chair of the Activating Success Awards Committee, Tracey Grose at Tracey.Grose@ddsb.ca
A. Personal Information
B. Leadership roles within your school
Activities
Supervising Staff Member
Dates
C. Community Service
Activities
Organization and/or Location
Dates
D. References (please provide one reference, i.e. teacher / parent / community member, etc.)
Name
Title/Position
Phone Contact AM
Phone Contact PM
Name of Applicant
Date of Birth
Home Address (including postal code)
Phone Number Cell Number
Name of School (attendance must be current)
Grade
Print Form
Submit by Email
E. Reference, please write a two paragraph statement about how the applicant has demonstrated leadership in
their community
With all application submissions, please include a paper or scanned copy of your most recent report card or transcript
and send to:
Tracey Grose Chair Activating Student Success Committee
Durham Black Educators Network
400 Taunton Road East
Whitby, Ontario
L1R 2K6
905-666-5500 ext. 5342
Tracey.Grose@ddsb.ca.
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