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VIP Agency Application
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Agency Name
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Address
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Street Address
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About the Agency
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Years at the Agency
*
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*
Current Organizational Budget
*
Agency Mission
*
Briefly describe your agency’s programs and services.
*
Briefly describe your agency’s clients/constituents.
*
About the Board
Board Chair/President
*
Number of Board Meetings Annually
*
Number of Board Members
*
Term Limits
*
Number of Terms
*
Location of Board Meetings
*
Time of Day of Board Meetings
*
Committees
*
Meetings Per Year
*
Is there an attendance policy?
*
Yes
No
Please describe the attendance policy
Are board members required to make a financial contribution?
*
Yes
No
Please describe the required financial contribution
Are there any other special requirements of board members?
*
Yes
No
Please describe any special requirements?
Do you accept fully remote board members?
*
Yes
No
Please describe your remote board member policy
How have board members been recruited in the past?
*
Describe the board’s nominating policies and procedures.
*
Describe the board’s orientation program and process.
*
Describe the relationship and interaction between the board and the executive director.
*
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Does your organization currently have Directors and Officers Insurance?
No
Yes
Does your organization currently have Directors and Officers Insurance?
*
Yes
No
Describe your ideal board candidate, including skills needed.
*
Communication
Once we have a candidate, who should be notified?
Name
*
Phone
*
Who will interview the candidate?
Name
*
Phone
*
Please include the following, if available:
Board Roster
Including business affiliation and length of board service.
Max. file size: 50 MB.
Promotional Brochures
Max. file size: 50 MB.
Other materials that describe your agency’s programs and services
Max. file size: 50 MB.
Form completed by:
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Name
*
First
Last
Email
*
Title
*
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Email
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Agency Name
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Fax
Email
*
Website
About the Agency
Executive Director
*
Years at the Agency
*
Number of Staff (Full and Part Time)
*
Current Organizational Budget
*
Agency Mission
*
Briefly describe your agency’s programs and services.
*
Briefly describe your agency’s clients/constituents.
*
About the Board
Board Chair/President
*
Number of Board Meetings Annually
*
Number of Board Members
*
Term Limits
*
Number of Terms
*
Location of Board Meetings
*
Time of Day of Board Meetings
*
Committees
*
Meetings Per Year
*
Is there an attendance policy?
*
Yes
No
Please describe the attendance policy
Are board members required to make a financial contribution?
*
Yes
No
Please describe the required financial contribution
Are there any other special requirements of board members?
*
Yes
No
Please describe any special requirements?
Do you accept fully remote board members?
*
Yes
No
Please describe your remote board member policy
How have board members been recruited in the past?
*
Describe the board’s nominating policies and procedures.
*
Describe the board’s orientation program and process.
*
Describe the relationship and interaction between the board and the executive director.
*
This field is hidden when viewing the form
Does your organization currently have Directors and Officers Insurance?
No
Yes
Does your organization currently have Directors and Officers Insurance?
*
Yes
No
Describe your ideal board candidate, including skills needed.
*
Communication
Once we have a candidate, who should be notified?
Name
*
Phone
*
Who will interview the candidate?
Name
*
Phone
*
Please include the following, if available:
Board Roster
Including business affiliation and length of board service.
Max. file size: 50 MB.
Promotional Brochures
Max. file size: 50 MB.
Other materials that describe your agency’s programs and services
Max. file size: 50 MB.
Form completed by:
This field is hidden when viewing the form
Name
Name
*
First
Last
Email
*
Title
*
Thank you for contacting us.
We have received your message and will get back to you soon!
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