PLI app final PLI of Polk 2.0 2019 proposed application (fillabl | Page 3

1. Please describe (in 300 words or less) what you view as the most important local public-policy issue
(or issues) facing the business community where you live or work and your proposed solution:
___________________________________________________________________________________
2. Please list any leadership roles you currently hold or have held within the past five years in profes-
sional, business, civic or social organizations.
In addition, please describe any accomplishment(s) that resulted from a leadership role in a profes-
sional, business, civic or social organization (not including employment) within the past five years.
If this question does not apply to you, do you plan on becoming more engaged in the community?
How? In what area(s)? Do you have a strategy or timetable for involvement?
________________________________________________________________________________
________________________________________________________________________________
3. Which educational goal is MOST important to you at this time?
Please check ONLY one:
learning about the local political environment with an interest in engaging in public affairs
exploring what it takes to run for office, without making a commitment
seeking opportunities to land a volunteer appointment to a government board or commission
becoming an advocate on small business issues in public affairs
learning about the local political environment with NO interest in engaging in public affairs
4. Have you ever held an elected or appointed government office or served on a government board,
task force or commission? Yes No If yes, please list the office(s) or board(s) and years served:
5. Have you been a candidate for political office?
Yes
No If yes, what was the office and when did you run? ______________________
6. Have you ever served in a paid capacity on or for a political campaign, political party or campaign
organization? Please describe your role and list the campaign(s) or organization.
7. Have you served in the military? If yes, please list the military branch, years of service, rank and dis-
charge status: