BoardStrong Nonprofit Organization CEO/Board Chair Leadership Program

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* 1. Name of Organization

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* 2. Organization Contact Information

Address

Address 2

City/Town, State, Zip Code

Phone Number

Email Address

Website

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* 3. Executive Director Information

Name

Number of years working for the organization

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* 4. Board Chair/President Information

Name

Number of years on the Board

Number of years as Chair/President

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* 5. Organization's Mission Statement

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* 6. Most recent annual operating budget size

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* 7. Number of individuals served annually (if applicable)

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* 8. Source of Revenue (Percentage)

Board

Private and Corporate Contributions

Foundations

Public Sources (city, state, federal government grants)

Earned Revenue

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* 9. Current Number of Board Members

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* 10. Number of Full Annual Board Meeting

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* 11. Average Board Member Attendance

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* 12. Check the box if your Board has any of the following:

Terms of Office

Term Limits

Contribution Policy (e.g. a give/get or requirement that all board members make meaningful financial contribution)

Committees

Board Self-Assessments

A Succession Plan

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* 13. Has your Board conducted a Diversity, Equity, Inclusion and Accessibility training or assessment?

Yes

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* 14. Your Board includes how many members who are:

Female

Male

Non-Binary

Other

Don't Know

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* 15. How many of your Board members identify as:

African American/Black

Caucasian/White

Hispanic, Latino, or of Spanish Origin

East Asian or Asian American

South Asian

American Indian or Alaska Native

Native Hawaiian or Pacific Islander

Other race, ethnicity, or national origin

Don't Know

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* 16. How many Board members identify as:

Under 20 Years of Age

20-29

30-39

40-49

50-59

60-69

70+

Don't Know

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* 17. Where is your organization in the Nonprofit Lifecycle:

Start-up

Transitioning to a governing board

Mature

Turnaround

Explain your response:

BoardStrong Nonprofit Organization CEO/Board Chair Leadership Program

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* 1. Name of Organization

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* 2. Organization Contact Information

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* 3. Executive Director Information

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* 4. Board Chair/President Information

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* 5. Organization's Mission Statement

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* 6. Most recent annual operating budget size

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* 7. Number of individuals served annually (if applicable)

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* 8. Source of Revenue (Percentage)

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* 9. Current Number of Board Members

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* 10. Number of Full Annual Board Meeting

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* 11. Average Board Member Attendance

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* 12. Check the box if your Board has any of the following:

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* 13. Has your Board conducted a Diversity, Equity, Inclusion and Accessibility training or assessment?

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* 14. Your Board includes how many members who are:

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* 15. How many of your Board members identify as:

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* 16. How many Board members identify as:

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* 17. Where is your organization in the Nonprofit Lifecycle:

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* 18. What are the top three challenges your Board faces?

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* 19. Please tell us how your Board Chair and Executive Director would benefit from this program.