VIP Agency Application - United Way of Greater AtlantaUnited Way of Greater Atlanta

1About the Agency

2About the Board

3Final Details

Agency Name
Address*
Street Address Address Line 2 City 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
Attendance
- Is there an attendance policy?
Please Describe
Financial Requirements?
- Are board members required to make financial contributions?
Please Describe
Special Requirements
- Are there any other special requirements of board members?
Please Describe
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.
Untitled
Does your organization currently have Directors and Officers Insurance?
- No
- Yes
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:
Name
Title