PLI Political Leadership Track Application

First Name *

Last Name *

Preferred Name

Email *

Current Employer *

Job Title *

Date of Birth YYYY-MM-DD

Residential Address *

Address Two

City *

State *

Country *

Zip Code *

Leadership Orlando Graduate * YesNo

Please identify what you believe is the most important public policy issue or concern (choose one) facing the business community in the Central Florida region or your community? * Explain why the issue merits attention and describe how you would propose addressing it, if given the opportunity. (In 300 words or less)

Please list and describe any leadership roles and accomplishments within the past five years. * (In 200 words or less; not a list of memberships - include professional, business, civic or social organizations outside of regular employment)

What government level interests you most as you consider public leadership? * FederalStateLocal (choose one)

What is your estimated timeline for seeking office? *

Have you publicly announced or filed a candidacy for elected office? * YesNo If yes, please discontinue this application. The program cannot accept declared candidates for political office.

If chosen to participate in the Political Leadership Track program, what specifically do you hope to learn about candidacy or the appointment process? * (In 150 words or less)

Have you ever held an elected or appointed office or served on a government board, task force or commission? * YesNo

Have you ever been a candidate for political office or served as a paid staff member on a political campaign? * YesNo

Have you ever been convicted, pled no contest, been placed on probation, fined, entered a pre-trial intervention program or had adjudication withheld by any judicial or quasi-judicial body for any felony or misdemeanor other than minor traffic violations? * YesNo

Have you read, understood and agreed to the program's attendance requirement detailed on the application's cover page? * Yes I have read and understood the cover letter, including attendance requirement. I have not filed paperwork with any government entity declaring my candidacy for political office. While the program exists to build the bench of business-minded future candidates, PLI cannot accept currently filed candidates.

Has your employer agreed to allow you time off to participate in the program's activities should you be selected? * YesNoN/A

Are you registered to vote? * YesNo

Did anyone refer you? (Please include their name and email.)

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