J.D. Elliott Governance Catalyst: Cohort 2 Application

Eligibility & Participation Requirements

To apply for the Governance Catalyst, you must meet all of the following criteria:

1. A grant recipient of The Memorial Foundation within the past three (3) years
2. A current member of the Center for Nonprofit Management
3. A current profile on the Community Foundation’s GivingMatters.com website

Applicants must:

Submit a completed application no later than August 12, 2016 at 5:00 p.m.
Be prepared to cover the agency out-of-pocket portion of the costs of $175.
Commit to full participation in the Governance Catalyst program:
- Designating this project as a strategic priority
- Full participation in the three group sessions by BOTH the CEO and the Board representative (Board Chair or Chair-Elect)
- Completion of assignments necessary to fully participate in group sessions
- Integration of best practices with the full board as part of the organization’s ongoing governance policies and procedures

Question Title

* 1. Agency Information

Agency name:

Year agency founded:

Agency CEO name:

Agency CEO email:

Agency Board Chair-Elect (or Board Chair) name:

Agency Board Chair-Elect (or Board Chair) email:

What is your organization's mission?

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* 2. Agency Location

Street address:

City:

State:

Zip:

Telephone:

Website:

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* 3. Agency Budget Information

Revenues for current fiscal year:

Expenses for current fiscal year:

Revenues for most recently completed fiscal year:

Expenses for most recently completed fiscal year:

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* 4. Current CNM member?

Yes

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* 5. Current GivingMatters profile?

Yes

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* 6. Last grant from The Memorial Foundation:

Amount:

Date: