Board Fellowship Organization Application 

 General Information

 

Organization Name:   
Street Address:   
City, State, Zip:   
Website:    
Organization Phone:    
Organization Email:    
 Executive Director:   
 Name of Board Chair:   
 Date Org. Established:   


 

Organization Mentors 

The most important relationship in our program is between the student and Board Mentor. A staff member is important to stay connected to the operations, but the primary relationship is with the board mentor.

 

Name of Board Member/Mentor:    
(Professional) Employer Company/Title:   
Board Mentor Phone:    
Board Mentor Email:   
Name and Title of Executive Staff Contact:   
Staff Contact Phone:   
Staff Contact Email:    

 

 Mission and Services

Please check the category that best represents your organization’s mission:  

                 
 
Organization Mission Statement: 
 		  
Please describe the major programs or services within your organization: 
 		  

 

Board Operations 

 

Number of Board Members:  

Please provide details about your board meetings:

 
Number per year:  
Average Meeting Length:  
Day of Week/Month:  
Typical Location(s):  

 

Please indicate the skills and expertise you wish to add to your board (check all that apply):

(This information is useful in matching your Board Fellow.)

                 
 

 

Please estimate the average number of hours an individual board member contributes each month (including outside of meetings):

                        
 

How many Board Fellows would you like placed on your board?

                          
 

 

Financial Information

 Annual Budget:  
 Number of FTEs:  

 

Top three major funders (need not disclose amounts):


1.

 

2.  

 

3.  

 

Board Agreement

 Please provide the following documents:

  • List of current board of directors, including full name, affiliation, title/position, beginning and ending dates of board term
  • Copy of board minutes showing a resolution to participate in the Board Fellowship Program and oversee and support a board fellow (see Board Agreement section)
  • Any additional material you think would be helpful (e.g., annual report, newsletter, financial audit, brochure)

 

Printed Name:   
Date:   [None] Select a Date Delete the Date
 
Title:   

 

Contact:

Parvez Ahmed, Director
pahmed@unf.edu
904-620-1678