LEADERSHIP OCALA/MARION APPLICATION FOR BOARD OF REGENTS Deadline: Friday, May 15, 2015 Return to Jaye Baillie, Director of Business Service 310 SE Third Street, Ocala, Fl 34471 Or email to Jaye@OcalaCEP.com *applicants applying for one board, may be asked to consider service on another This application is for the following Board*:  Leadership Ocala/Marion Youth  Leadership Ocala/Marion  Leadership Ocala/Marion Alumni Name: Company: Title: Address: City, ST Zip: Office Phone: Mobile: Preferred E-mail: Are you a graduate of any Leadership Ocala/Marion Program? If yes, graduate of Leadership Class____________  Yes  No Are you a member of Leadership Ocala/Marion Alumni  Yes  No Are you a graduate of any Leadership Program?  Yes  No Are you currently serving on any LOM Board? Which One? _____________  Yes  No Are you personally or is your business a member of the CEP? If not would you be willing to become a CEP Partner?  Yes  Yes  No  No Name of Program: _________________________________ On a separate sheet of paper, please answer the following questions: 1. Why are you interested in serving on one of the Board of Regents? 2. What specific expertise or talent will you bring to the Board of Regents? 3. What leadership roles have you undertaken in the past (both professionally and personally)? 4. On what other Boards have you served?