EXIT Part 1: Agency Contact and Demographic Information Question Title * 1. Name of Agency OK Question Title * 2. Main Office Address OK Question Title * 3. Agency Phone Number OK Question Title * 4. City, State, Zip OK Question Title * 5. Name of Agency CEO OK Question Title * 6. CEO's Direct Phone Line OK Question Title * 7. CEO's Cell # OK Question Title * 8. CEO's Email Address OK Question Title * 9. If your agency has the following staff members, please list name and email address and best phone number to contact them . Assistant/Associate Director CFO COO Program Manager Clinical Director Director of Development Communications/Marketing Professional Human Resources Professional Information Technology Professional Volunteer Services Professional Advocacy Liaison Executive Administrative Assistant OK Question Title * 10. Name of Board President OK Question Title * 11. Name of Board President Elect OK Question Title * 12. Please indicate the approximate percentage of the following that are Jewish 0-10% 0-10% 11-20% about 25% 26-40% about 50% 51-70% about 75% 100% Clients Clients 0-10% Clients 0-10% Clients 11-20% Clients about 25% Clients 26-40% Clients about 50% Clients 51-70% Clients about 75% Clients 100% Board of Directors Board of Directors 0-10% Board of Directors 0-10% Board of Directors 11-20% Board of Directors about 25% Board of Directors 26-40% Board of Directors about 50% Board of Directors 51-70% Board of Directors about 75% Board of Directors 100% Volunteers Volunteers 0-10% Volunteers 0-10% Volunteers 11-20% Volunteers about 25% Volunteers 26-40% Volunteers about 50% Volunteers 51-70% Volunteers about 75% Volunteers 100% OK Question Title * 13. Please list the number of clients your agency has served in each of the following demographic groups during the last fiscal year: Adolescents Ex-offenders Infant/Toddlers Jewish Long Term Unemployed Older Adult Workers (55+) Older Adult Workers Not employed Persons with Disabilities Refugees/Immigrants School Age Children Veterans Welfare Recipients Young Adults (ages 18-22) Other Total Clients Served OK Clicking the Next button below will save your data so you can edit it later. Please remember to use same computer and browser.... OK NEXT
