OPTIMIST INTERNATIONAL LEADERSHIP ACADEMY APPLICATION
Personal Informaon
First Name: Last Name:
Mailing Address:
City: State/Providence:
ZIP/Postal Code: Country:
Home phone: __ Work phone:
Cell phone: E-mail address:
Profession/occupaon:
Opmist Informaon
Club Name: Date Joined:
Member Number:
Which year were you Club President? ____________ Honor? __Yes __No Disnguished? __Yes __No
Which year were you a Lt. Governor? ____________ Honor? __Yes __No Disnguished? __Yes __No
Wrien Submission
In 1,000 words or less, please explain what qualies a “good leader” should possess and why. Addionally,
please list your personal strengths and weaknesses. Response must be typewrien. Submission must be
received by Opmist Internaonal no later than March 1, 2018.
Send to:
Opmist Internaonal
An: Leadership Development Commiee
4494 Lindell Blvd., St. Louis, MO 63108
E-mail: leadership@opmist.org
Fax: 314-735-4106