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* 1. Name of Organization:

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* 2. Please provide the organization's contact information below:

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* 3. Organization's Mission Statement:

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* 4. Most recent annual operating budget size:

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* 5. Number of individuals served annually (if applicable):

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* 6. Source of Revenue (%)

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* 7. Board Information

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* 8. Does your board have:

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* 9. Percentage of your board members that contributed financially to your organization in your most recently completed fiscal year:

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* 10. Has your organization conducted a Diversity, Equity and Inclusion assessment?

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* 11. How many of your board members identify as:

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* 12. How many of your board members identify as:

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* 13. How many of your board members are:

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* 14. Where is your organization in the nonprofit life cycle?

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* 15. Please tell us how your organization would benefit from Governance Matters consulting services. For example, is there a goal you could achieve with stronger board governance?

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