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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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