Please take a few minutes to provide Jericho Road Project with this important information about your organization and your board. Your organization’s Executive Director or the Chair of the Board may fill out the form.

Make sure you answer all questions that have an asterisk (*). The information requested on this form is critical to our training and matching process and, with your permission, may be shared with potential new board members participating in the TLC program.

Applications must be received at least 2 weeks before the start of the program.

To be eligible for placement of a corporate executive on your board, your organization must send at least one current board member to the TLC training. Your Executive Director may also choose to attend. TLC encourages nonprofit participation in all four sessions of the program.

Note: There is no mechanism in this online application system for you to save a partially completed form. Because of this, please take a few minutes to review the application before you fill it out to ensure that you have all of the information you'll need to complete all of the questions, and then fill out the entire application in one sitting. Thanks!

* 1. Our organization would like to attend the following TLC seminar series (Additional dates and locations will be posted soon)

* 2. Nonprofit Name

* 3. Please give a short description of your nonprofit to include with the program notes

* 4. What is the primary focus of your organization?

* 5. What communities or segments do you serve? (For example, homeless youth of Lowell)

* 6. Nonprofit Street Address

* 7. City, State, Zip Code

* 8. Website Address

* 9. Attendee's Name

* 10. Attendee's Title (e.g. Vice-Chair, Treasurer) if applicable

* 11. Attendee's email

* 12. Attendee's phone/cell phone

* 13. How many members do you have on your Board currently?

* 14. How often does your Board meet?

* 15. How long is your Board term?

* 16. In your opinion, what topic(s) are of greatest interest or need for your organization (check all that apply)

* 17. How many clients do you server a year?

* 18. Approximately, what % of your clients is considered low to moderate income?

* 19. What is your organization's primary measure / metric of success or service? For example, number of families served, number of pounds of food provided, etc.

* 20. What is approximate value / number of that measure or metric for the past reporting period (week, month, year, etc.) and for what reporting period? For example, 100 for the past month or 1000 for the year, etc.

* 21. As a result of this training, what improvement in your measure / metric do you hope to achieve? For example, a 10% increase in families served, etc.

The next 3 questions will help maximize your learning from the TLC program by helping the presenters make sure your questions are answered.

* 22. What is ONE question you would absolutely like the presenter to address regarding non-profit governance?

* 23. What is ONE question you have regarding financial oversight?

* 24. What is ONE question you have regarding revenue generation?

* 25. Use the space below if you would like to add any additional information about your board or non-profit.

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