Please indicate which BVU services your organization is seeking (check all that apply): Please indicate which BVU services your organization is seeking (check all that apply): Referral of board members Referral of volunteer consultants for operational issues Referral of direct services volunteers Training/development for board Succession Planning Strategic Planning Do not know Other

Your Name:

Your Title:

Your Email:

Chief Executive's Name (if different from requester):

Chief Executive's Email (if different from requester):

Organization Name:

Nonprofit Establishment Date:

Address:

State

City:

Zip Code:

Phone Number:

Please describe your organization's mission and services:

Regions served by your organization: Regions served by your organization: Cuyahoga County Lorain County Summit/Portage/Stark/Tuscarawas Counties Geauga County Lake/Ashtabula Counties Medina County

Organization Annual Budget:

Number of paid full-time staff or (FTE):

Website:

Please describe your agency in terms of its current stage of development: Please describe your agency in terms of its current stage of development: Start up Growth Established Undergoing Important Transition Crisis

Please check all that apply in relation to your organization's mission and services: Please check all that apply in relation to your organization's mission and services: Arts, Culture & Humanities Cultural Disease Education Environment/ Animals Health Issues Human/ Social Services Other Religion

Name of Board Chair

Board Chair's email address:

Number of current board members

Are you interested in receiving Board Member referrals? Are you interested in receiving Board Member referrals?yesno

Board Meeting Frequency: Board Meeting Frequency: Quarterly Bi-Monthly Monthly Other

Board office number

Please indicate how many new board members you are seeking

Is there a personal financial contribution required of board members? Is there a personal financial contribution required of board members? Yes No

If there is a personal financial contribution, what is the minimum required?

Would you like to become a member? Would you like to become a member? Yes No Already a Member

Is there anything else that you would like us to know about your organization or your organization's board?