SurveyMonkey Powered Online Survey

The following application for Build Your Own Board (BYOB) will take approximately 20-30 minutes to complete. Before you begin, please be sure you have read the BYOB Program Description on the PEJE website. If you do not complete the application, you may return to complete your answers from the same computer.

Question Title

* 1. Please identify the key staff person who will be the primary contact for the BYOB program. This person will be PEJE’s first contact with information or updates about the program.

Name:

Title:

Email Address:

Phone Number:

Question Title

* 2. School information (for schools with multiple campuses, please provide the address used for administrative purposes):

School Name (no abbreviations please): *

Website: *

Mailing Address: *

City/Town: *

State/Province: *

ZIP/Postal Code: *

Country:

Fax: *

Phone: *

Question Title

* 3. Head of School (or equivalent):

Name:

Title:

# of Years in Current Position

Mailing Address:

City/Town:

State/Province:

ZIP/Postal Code:

Email Address:

Phone Number:

Question Title

* 4. Chair/President of Board:

Name:

Title:

# of Years in Current Position

Mailing Address:

City/Town:

State/Province:

ZIP/Postal Code:

Is this info for School/Work/Home?

Email Address:

Phone Number:

Question Title

* 5. Committee on Trustees/Governance Committee Chair (or equivalent):

Name:

Title:

# of Years in Current Position

Mailing Address:

City/Town:

State/Province:

ZIP/Postal Code:

Is this info for School/Work/Home?

Email Address:

Phone Number:

Question Title

* 6. Who staffs the Committee on Trustees (or equivalent)?

Name:

Title:

Mailing Address:

City/Town:

State/Province:

ZIP/Postal Code:

Is this info for School/Work/Home?

Email Address:

Phone Number:

Question Title

* 7. Is there a committee/s on your board that performs the following functions?

	Yes/No	Name of body on Board doing this work
Profile Board Needs	Profile Board Needs Yes/No menu	Profile Board Needs Name of body on Board doing this work menu
Identify Potential Board Members and Board Leaders	Identify Potential Board Members and Board Leaders Yes/No menu	Identify Potential Board Members and Board Leaders Name of body on Board doing this work menu
Cultivate Potential Board Members and Board Leaders	Cultivate Potential Board Members and Board Leaders Yes/No menu	Cultivate Potential Board Members and Board Leaders Name of body on Board doing this work menu
Recruit Identified Board Members and Board Leaders	Recruit Identified Board Members and Board Leaders Yes/No menu	Recruit Identified Board Members and Board Leaders Name of body on Board doing this work menu
Orient Board Members	Orient Board Members Yes/No menu	Orient Board Members Name of body on Board doing this work menu
Involve Board Members	Involve Board Members Yes/No menu	Involve Board Members Name of body on Board doing this work menu
Educate Board Members	Educate Board Members Yes/No menu	Educate Board Members Name of body on Board doing this work menu
Evaluate Board Members	Evaluate Board Members Yes/No menu	Evaluate Board Members Name of body on Board doing this work menu
Rotate Board Members	Rotate Board Members Yes/No menu	Rotate Board Members Name of body on Board doing this work menu
Celebrate Board Members	Celebrate Board Members Yes/No menu	Celebrate Board Members Name of body on Board doing this work menu

Other (please specify other bodies of your board performing the functions of a Committee on Trustees):

Question Title

* 8. Select the periods during which any one of these committees met at least once in the last year to work on any of the functions above (Mark all that apply):

September – November

December – February

March – May

June – August

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