Date: *


Institution: *


Name of CEO & Current Time in Position (yrs.): *


Board Chair & Current Time in Position (yrs.): *


Chief Development Officer & Current Time in Position (yrs.): *


Chief Financial Officer & Current Time in Position (yrs.): *


Size of Institution (hospital beds, FTE students, # of alumni, clients served, etc.): *


Number of Board Members: *
1-5
6-10
11-15
16-20
21-25
26+

Number of Board Member Attending Meetings: *
1-5
6-10
11-15
16-20
21-25
25+

Is There an Established Board Manual / Training Program: *
Yes
No

Focus of Training: *


Length of Term for Board Members: *


Focus of Training: *


Length: