Leadership Ocala Marion Class XXIX

Leadership Ocala Marion Class XXIX
Confidential Application
Application Deadline Tuesday, June 30, 2015 by 4:00 PM
The online application is available on OcalaCEP.com
Please submit signed/scanned application via email to Jaye@OcalaCEP.com
Or mail or hand deliver to CEP 310 SE Third Street, Ocala, FL 34471
Please type or print your responses and answer all application questions completely. Limit your
answers to the space provided unless otherwise indicated.
First Name
Last Name
Name for Name Badge
Current Employment:
Mailing Address:
Business Phone #:
Cell Phone #:
Email (work or home):
Shirt Size:
Report to (title):
If LOM alumnus, check
Duties & responsibilities (include any budgetary authority, supervisory responsibilities, number of people
Please list any special awards, accomplishments, honors, offices held, etc., during your academic and
professional career:
Home Address:
Home Phone (if applicable):
How long have you lived in Marion Country?
Have you ever participated in a leadership program before? ____________________________________
Community Leadership
Please complete the following and attach your resume.
Please describe present or past volunteer community involvement, including any leadership positions you have
held (begin with most recent). Additional sheets of paper may be added.
Organization & Dates of participation:
Your Responsibilities:
Office Held (incl. committees):
Organization & Dates of participation:
Your Responsibilities:
Office Held (incl. committees):
Organization & Dates of participation:
Your Responsibilities:
Office Held (incl. committees):
Short Essays
On a separate paper for each question, please respond to the following; please limit your responses to 300
words per question.
1. To date, what do you consider your most significant civic or community contribution?
2. What unique qualities will you bring to your Leadership Ocala/Marion class?
3. Describe your vision for the future of the Ocala MSA and tell us what role you will play in helping
achieve it. Be specific about the activities you will pursue.
4. Share with us why you are interested in the program and how involvement in Leadership Ocala/Marion
can benefit the plan you outlined in Question 3.
Recommendations & Time Commitment Contract
Please submit recommendations from your immediate supervisor (unless you are the highest level
manager in your organization), and from a LOM Alumnus (see attached form)
I understand the Leadership Ocala/Marion program requires attendance at the Orientation on Wednesday,
September 2, 2015 (3-8 PM), SIMSOC on Thursday September 3, 2015, (8AM – 5PM) and Ropes course on
Saturday, September 5, 2015 (8AM – 4PM). Furthermore, I understand that I must attend all of the remaining
full day, monthly sessions, in their entirety and will be allowed to miss only two sessions to remain in the class
and graduate from the program.
If selected, I will fulfill all obligations outlined in this application and will pay my tuition upon acceptance.
Applicant’s Signature:
Employer’s Signature (if applicable)
This applicant has my full support to participate in Leadership Ocala/Marion. I am aware of the time
commitment involved for his or her participation in the program.
Employer/Supervisor’s Name:
Employer/Supervisor’s Signature:
To be completed by immediate supervisor and/or Leadership Ocala/Marion alumnus
Please use this form or use the information on this form as a guideline for preparation of a separate letter of
recommendation. The recommendation must be received by the applications deadline, as stated in the class
As you answer the questions below, use the additional paper if needed, but please be concise as possible.
Check applicable box(es):
Supervisor of applicant
Leadership Ocala/Marion Alumnus
Name of Applicant:
Length of Acquaintance:
Type of Relationship—Please Check a Box Below:
Close Personal Relationship
Occasional Business Contact
Regular Business Contact
Occasional Social Contact
Regular Social Contact
Principally by Reputation
Give Details of your knowledge of applicant’s participation in civic and community activities:
Other pertinent information:
Reasons applicant will make an outstanding LOM participant:
Name of person making recommendation:
 Applicants must be a CEP partner before applying. For information on CEP Partnership,
please contact Dawn@OcalaCEP.com
 Discounts apply for select CEP Partner levels. For more information, contact
 Incomplete applications will not be accepted
 All applications will be reviewed by the Board
 The Board reserves the right to interview applicants.