Fuqua On Board 2011-2012 NONPROFIT Sign-up Survey

Thank you for your interest in the Fuqua On Board program, managed by the Center for the Advancement of Social Entrepreneurship (CASE) at Duke's Fuqua School of Business.

Nonprofit organizations must complete this application to be considered for the program. We greatly appreciate your time and effort. Your thoughtful responses are critical to our ability to select students for the program and to match your organization effectively with the students who may be of greatest assistance to you. Nonprofits that participated in previous years may skip several questions if their answers from last year remain unchanged.

More information about FOB can be found on the internet at http://www.fuquaonboard.org. Information about CASE, including a calendar of upcoming speakers and events, can be found at http://www.caseatduke.org.

Please note that if you submit this application after August 15th, we may not be able to consider your organization for this year's program, depending on the number of applications received by that date.

We will contact you in mid to late August if we have any questions about your application. If you have any questions about the program, please contact CASE Executive Director Matt Nash at FOB@fuqua.duke.edu or (919) 660-7791.

NOTE -- If you do not have reliable internet access, or if you prefer not to submit your responses online, you may answer all questions in a separate Word document and send an electronic version to FOB@fuqua.duke.edu .

See bottom of this survey for instructions on how to print a hard copy or save a soft copy for your records.

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1. Organization Name:

Organization Name:

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2. Contact Person:

Contact Person:

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3. Position/Title of Contact Person:

Position/Title of Contact Person:

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4. Mailing Address:

Mailing Address:

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5. Telephone(s):

Telephone(s):

6. Fax:

Fax:

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7. E-Mail:

E-Mail:

8. Website (if any):

Website (if any):

9. Number of full-time staff members?

Number of full-time staff members?

10. Number of volunteers?

Number of volunteers?

11. Approximate amount of annual budget?

Approximate amount of annual budget?

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12. Eligibility: For each of the following criteria, please indicate YES or NO by checking as appropriate.

	YES	NO
A. Your organization is a nonprofit based in Durham, North Carolina	*Eligibility: For each of the following criteria, please indicate YES or NO by checking as appropriate. A. Your organization is a nonprofit based in Durham, North Carolina YES	A. Your organization is a nonprofit based in Durham, North Carolina NO
B. You have a reasonably stable board of directors that meets at least quarterly (NOTE: Monthly board or committee meetings are preferable in order to maximize opportunities for student participation and learning)	B. You have a reasonably stable board of directors that meets at least quarterly (NOTE: Monthly board or committee meetings are preferable in order to maximize opportunities for student participation and learning) YES	B. You have a reasonably stable board of directors that meets at least quarterly (NOTE: Monthly board or committee meetings are preferable in order to maximize opportunities for student participation and learning) NO
C. You are willing to invite two students to participate in a non-voting role in board and committee meetings on a regular basis	C. You are willing to invite two students to participate in a non-voting role in board and committee meetings on a regular basis YES	C. You are willing to invite two students to participate in a non-voting role in board and committee meetings on a regular basis NO
D. You are able to provide mentoring and supervision to students assigned to your board (including a staff liaison AND a board member "mentor")	D. You are able to provide mentoring and supervision to students assigned to your board (including a staff liaison AND a board member "mentor") YES	D. You are able to provide mentoring and supervision to students assigned to your board (including a staff liaison AND a board member "mentor") NO

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13. Has your organization participated in Fuqua On Board in the past?

Has your organization participated in Fuqua On Board in the past? YES - We participated last year [may also have participated in previous year(s)]

YES - We have participated in the past, but NOT last year

UNCERTAIN

14. What is the mission of your organization? [NOTE: You may skip this question if your organization participated last year and your answer remains the same as last year.]

What is the mission of your organization? [NOTE: You may skip this question if your organization participated last year and your answer remains the same as last year.]

15. Please provide a BRIEF summary of your organization's main activities/programs. [NOTE: You may skip this question if your organization participated last year and your answer remains the same as last year.]

Please provide a BRIEF summary of your organization's main activities/programs. [NOTE: You may skip this question if your organization participated last year and your answer remains the same as last year.]

16. What are the key challenges that your organization is currently facing? How can Duke MBA students assist your board in addressing these issues?

What are the key challenges that your organization is currently facing? How can Duke MBA students assist your board in addressing these issues?

17. At what frequency does your board meet?

At what frequency does your board meet? More Than Once Per Month

Once Per Month

Every Other Month

Quarterly

Less Than Quarterly

Other (please specify):

18. WHEN (day of week and time of day) and WHERE does the board meet?

WHEN (day of week and time of day) and WHERE does the board meet?

19. Please tell us a bit about your board of directors. (For example: Number of members? Does the board work well together? Is the board actively involved in strategic decision making? Do board committees function effectively? Are there any issues we should be aware of concerning the level of board development?)

Please tell us a bit about your board of directors. (For example: Number of members? Does the board work well together? Is the board actively involved in strategic decision making? Do board committees function effectively? Are there any issues we should be aware of concerning the level of board development?)

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20. Do you have any board committees, task forces, or project teams to which you would like to assign the students? (NOTE: As FOB is a volunteer activity and not for academic credit, the program does NOT include a formal consulting project; however, students are expected to contribute to a committee in a meaningful way and deliver a brief final report or presentation where appropriate.)

Do you have any board committees, task forces, or project teams to which you would like to assign the students? (NOTE: As FOB is a volunteer activity and not for academic credit, the program does NOT include a formal consulting project; however, students are expected to contribute to a committee in a meaningful way and deliver a brief final report or presentation where appropriate.) NO

UNCERTAIN

YES (please specify)

21. Additional Information (optional): Is there anything else that we should know that could help us match student board associates with your organization?

Additional Information (optional): Is there anything else that we should know that could help us match student board associates with your organization?

22. Which board member will serve as the students' "board mentor"? Please provide the name, title or position on the board, and contact information. (Leave blank if not yet known--details will be requested if and when students are assigned to your organization.)

Which board member will serve as the students' "board mentor"? Please provide the name, title or position on the board, and contact information. (Leave blank if not yet known--details will be requested if and when students are assigned to your organization.)

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23. Program Expectations & Norms: For each of the following, please confirm that you understand these expectations by checking YES or NO as appropriate.

	YES	NO
A. FOB is an extracurricular volunteer program; students do NOT receive academic credit, nor are they paid	*Program Expectations & Norms: For each of the following, please confirm that you understand these expectations by checking YES or NO as appropriate. A. FOB is an extracurricular volunteer program; students do NOT receive academic credit, nor are they paid YES	A. FOB is an extracurricular volunteer program; students do NOT receive academic credit, nor are they paid NO
B. Students expect to volunteer 10-12 hours per month, including time at board and committee meetings and at FOB training workshops and other sessions	B. Students expect to volunteer 10-12 hours per month, including time at board and committee meetings and at FOB training workshops and other sessions YES	B. Students expect to volunteer 10-12 hours per month, including time at board and committee meetings and at FOB training workshops and other sessions NO
C. Fuqua students pursue an intense course of studies consisting of 4 six-week terms, September-April. During examinations and vacation periods, students may not be available to participate in board activities	C. Fuqua students pursue an intense course of studies consisting of 4 six-week terms, September-April. During examinations and vacation periods, students may not be available to participate in board activities YES	C. Fuqua students pursue an intense course of studies consisting of 4 six-week terms, September-April. During examinations and vacation periods, students may not be available to participate in board activities NO
D. The students are MBA students with an average of 4-5 years work experience beyond college	D. The students are MBA students with an average of 4-5 years work experience beyond college YES	D. The students are MBA students with an average of 4-5 years work experience beyond college NO
E. The FOB program does NOT include a formal consulting project; instead, students are expected to make meaningful contributions to a board committee, task force, or project team and provide a final report	E. The FOB program does NOT include a formal consulting project; instead, students are expected to make meaningful contributions to a board committee, task force, or project team and provide a final report YES	E. The FOB program does NOT include a formal consulting project; instead, students are expected to make meaningful contributions to a board committee, task force, or project team and provide a final report NO
F. CASE welcomes participating nonprofits to join us for FOB training events and at special events and speakers throughout the year	F. CASE welcomes participating nonprofits to join us for FOB training events and at special events and speakers throughout the year YES	F. CASE welcomes participating nonprofits to join us for FOB training events and at special events and speakers throughout the year NO

24. Do you have any questions, suggestions, or concerns? (optional)

Do you have any questions, suggestions, or concerns? (optional)

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25. Today's Date:

Today's Date:

Thank you very much for taking the time to complete this application. We will be in touch with you within a few weeks.

NOTE -- Prior to clicking "Done" below and thereby submitting this application, you may wish to PRINT a hard copy for your records. You may do this by clicking on the printer icon on the top of your browser window, or by hitting the [CTRL] and [P] keys at the same time.

Alternatively, to save a soft copy of this form, click "File" at the top of your browser window, and then select "Save As..." Then, in the "Save as Type:" drop down box, select "Web Archive, single file (*.mht)" or "Text File (*.txt)"

Fuqua On Board 2011-2012 NONPROFIT Sign-up

*1. Organization Name:

*2. Contact Person:

*3. Position/Title of Contact Person:

*4. Mailing Address:

*5. Telephone(s):