Strategic Restructuring Assessment Application

Application for Participation in Phase 2: Strategic Restructuring Assessment

An exclusive opportunity for participants in the October 20 Learning Summit, hosted by Forefront.

Twenty applicants will be selected to receive a no cost facilitated assessment with La Piana Consulting, using the Strategic Restructuring Assessment Tool (SRAT.) Applications are due by November 11; you will be notified of your status within two weeks.

To help us determine if your organization is a good fit, please answer the following questions.

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* 1. Organization Name

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* 2. Organizational Information

Executive Director/CEO Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Executive Director/CEO Email Address

Executive Director/CEO Phone Number

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* 3. Website

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* 4. Board Chair Name

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* 5. Board Chair email

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* 6. Your Organization's Service Area (check all that apply)

City of Chicago - north side

City of Chicago - west side

City of Chicago - south side

West suburban

NW suburbs

South suburban

Central Illinois

Southern Illinois

Other (please specify)

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* 7. Briefly describe the constituents or client base to whom you direct your services:

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* 8. Briefly describe the services/activities/programs you provide:

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* 9. Annual budget in the current fiscal year (FY17):

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* 10. 'We receive more than 50% of our operating support from one of the following sources.' (Please check one.)

Government - Federal, State, and/or local gov't

Foundations

Individual donors

Corporate donors

We don't receive more than 50% from any one source.

Other (please specify)

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* 11. The following statement best describes my organization's financial situation:

Stable and/or growing.

Stressed and stretched, but able to maintain our current level of programs and services.

Vulnerable: cutting programs and worried about sustainability.