CNPL BoardPulse 2.0 Assessment Request Form Please complete this form to submit a request for your charity board to utilise the CNPL BoardPulse2.0 self-assessment tool for board performance. NVPC will be in touch to follow up on this request within 5 working days. Question Title * 1. Full name of organisation Question Title * 2. Unique entity number (UEN) Question Title * 3. Charity cause Animal Welfare Arts and Heritage Community Education Environmental Protection or Improvement General Charitable Purposes Health Religious Social and Welfare Sports Question Title * 4. IPC status Yes No Question Title * 5. Gross annual receipts or total expenditure (whichever is higher) in the last financial year Less than $10million $10million and above Question Title * 6. Current number of active board members that your organisation currently has Question Title * 7. Please enter the preferred closing date for the board member survey. NVPC will proceed to close the board member surveys on this date and generate the CNPL BoardPulse2.0 report within 5 working days. As a general rule of thumb, a period of around a month should suffice with reminders to board members. Alternatively, your charity may consider making the survey an agenda item. The individual surveys take around 20 minutes to complete.If an extension is required, please write to boardpulse@nvpc.org.sg. Date / Time Date Question Title * 8. Name of charity's point of contactThis point of contact will support the dissemination and completion of board member surveys. Question Title * 9. Email address of point of contact The board member survey link and report will be sent to this email address Question Title * 10. Acknowledgements I acknowledge that the dissemination of the board member survey link will be undertaken by my charity I acknowledge that driving participation of board members in the self-assessment exercise will be undertaken by my charity I acknowledge that if an extension for the board member survey period is required, I will write to boardpulse@nvpc.org.sg Done