Your Name:

Phone:

Email:

Arts Organization:

If serving as an officer on the board, what is your office?

List any committees on which you serve and indicate if you serve as chair:

Indicate the average number of hours you donate each month to the organization. Include meeting time, phone conversations, research and preparation time, attendance at performances, exhibits or events:

Please Select 1-3 hours per month 4-6 hours per month 7-9 hours per month 10+ hours

Comments:

Please list any contributions or purchases that you have made to benefit the arts organization. Include personal contributions, ticket or subscription purchases, tickets to fundraising events, etc. (covering the period from January 1- June 30, 2009):

Description:

Amount: $

Description:

Amount: $

Description:

Amount: $

Please list the source and amount of any gifts, sponsorships, grants or contracts that you have been involved in securing for your arts organization (covering the period from January 1- June 30, 2009):

Description:

Amount: $

Description:

Amount: $

Description:

Amount: $

Please list the type and amount of any in-kind services that you provided or secured for the arts organization. Include printing, photocopying, support staff time, supplies and equipment, meeting space, catering, etc. (covering the period from January 1- June 30, 2009):

Description:

Amount: $

Description:

Amount: $

Description:

Amount: $

In what ways has this experience benefited you personally or contributed to your professional development?

In what ways has the arts organization benefited from your involvement with them?

Describe the degree to which the board/organization has been successful in engaging you as a board/committee member (i.e. provided effective orientation to the board/organization, found a role for you to play, manages meetings well, keeps you interested in the organization).

Are you satisfied with your organization's governance practices and standards?1 = Unsatisfied; 5 = Satisfied

1  2  3  4  5

Comments:

Do you feel that your Business On Board training prepared you for service with your arts organization?1 = Not At All; 5 = Definitely

1  2  3  4  5

Comments:

Would you be interested in participating in ongoing Business On Board brief seminars covering the following topics?
1 = Not At All; 5 = Definitely

Making the Ask(fundraising)
1  2  3  4  5

Board/Staff Relationships
1  2  3  4  5

Effective Committees
1  2  3  4  5

Impact of Sarbanes-Oxley on Nonprofits
1  2  3  4  5

Nonprofit Financial Statements
1  2  3  4  5