Leo of the Year Entry Form

2015 Multiple District 201 LEO OF THE YEAR QUEST ENTRY FORM

1. PERSONAL DETAILS

Name: ______M /F

Address: ______

______

Telephone (H) ______(B) ______Fax ______

Email ______

Date of birth: ______Place of birth: ______

2. YOUR LEO HISTORY

Date joined: ______Name of club: ______

Have you changed Leo Clubs? YES / NO

If yes, please give details of all club membership, and any break/s in service.

Current Leo Club: ______

3. LEADERSHIP

List offices held in your Leo club/s: POSITION YEAR MAJOR INITIATIVES

List offices held at district, state or multiple district level: POSITION YEAR MAJOR INITIATIVES Explain how you have demonstrated your leadership ability in Leos:

4. SERVICE

List the major service activities of your current Leo club in the past year, and indicate your role in each activity: DATE SERVICE ACTIVITY YOUR INVOLVEMENT

5. DEVELOPMENT OF LEOS

List examples of your contribution to the development and growth of the Leo club program (eg. new members sponsored, new Leo clubs formed, publicity and promotional efforts)

6. ACHIEVEMENTS

What do you see as your major achievements in Leos? How have you benefited from Leo membership? How has it impacted on your goals and direction in life? 7. YOUR INTERESTS AND HOBBIES (OUTSIDE OF LEOS)

Please indicate your interests and skills, and your level of involvement in other activities:

8. COMMUNITY INVOLVEMENT (OUTSIDE OF LEOS)

List any clubs or organisations that you are involved with, and give a brief outline of how the community benefits by your contribution to each: CLUB/ORGANISATION: YOUR INVOLVEMENT:

9. EDUCATIONAL BACKGROUND

Level attained: Year:

Future educational goals:

10. EMPLOYMENT

CURRENT EMPLOYMENT: Employer: Part time /full time Position: Years in this position:

PREVIOUS EMPLOYMENT: Employer Position Years Part time/full time

11. KNOWLEDGE OF LIONS & LEOS

In your own words, please provide an outline of your understanding of the formation and history of the International Association of Lions Clubs, the initial formation and history of Leo Clubs and any other major aspects of the history of the family of Lionism.(Please limit this to two pages and attach it as Item 11 to your entry form) 12. OTHER

If you feel there are other aspects relating to you that have not been covered in this form then please add these as Item 12 on a separate sheet.

13. PHOTO Please attach a passport sized photograph of yourself, with the following wording and your signature on the back of it: “Lions may use this photo in Leo of the Year publications.”

………………………………………………………………………………….

CERTIFICATION

I submit this entry on the basis that the facts included are correct, and the views expressed are mine.

Signed: ______(Applicant )

Accredited by: ______(President of sponsoring Lions Club)

Authorised by: ______(District Leo Chairman)