Contact your DOD or Joe Ethier with any questions.

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1. Please select your state:

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2. Date:

Date

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3. Boys & Girls Club name:

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4. CEO Name:

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5. Board Chair Name:

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6. Board Chair Company & Title:

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7. Board Giving:  What is the percentage of your Board members giving?

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8. Board Team Participation:  Select the team's attendance percentage of regular board meetings.

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9. Community Relations:  The Board has members who have served on other service groups or agencies.  How have these affiliations helped your Boys & Girls Club?

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10. Board Policies & Documents:  Please check all that the Board has currently completed for your Boys & Girls Club:

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11. Resource Development:  The Board team is responsible for financial contributions to their Boys & Girls Club at the following level:

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12. Board Training:  Please provide the number of Board members who attended (if any) each Board training opportunity.

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13. Stronger Organization:  Please describe Board actions that have made the organization stronger in the past 12 months (ie: resource & personnel development, facility improvements, marketing, policy updates, etc.)

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14. Public Trust:  Please describe Board actions that have maintained and/or improved public trust of your Boys & Girls Club organization in the last 12 months (ie: financial reporting, audit, agency transparency, etc.)

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15. Additional Information:  Please list any other pertinent information you would like to share concerning the nominee's Club service, awards received, personal or family information, college attended, etc.

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16. Supporting Documentation:  Please upload any supporting documents here:

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