BoardsWork! Scholarship Application for Nonprofits Serving Children and Youth ORGANIZATION INFORMATION (Please note: Only GOVERNING boards are eligible for the BW! program) Organization Name: ______________________________________________________________________ Address: ______________________________________________________________________ City/State/Zip: ______________________________________________________________________ Phone/Website: ______________________________________________________________________ LEADERSHIP INFORMATION & SIGNATURES Executive Director: ___________________________________________________________________ Phone/Email: ___________________________________________________________________ ED Signature: ___________________________________________________________________ Board Chair: ___________________________________________________________________ Phone/Email: ___________________________________________________________________ Board Chair Signature: ___________________________________________________________________ By signing, I agree to participate in the full BoardsWork! process which includes:    Complete an assessment form, board survey, and subsequent conversation to shape the retreat Participate in a half-day board retreat with at least 75% of the board in attendance Choose matching service for 1-2 new board members OR training for 2 current board members FINANCIAL INFORMATION Annual Operating Budget $__________ Number of Employees (Full Time) __________ (Part Time)__________ Number of Board Members __________ BOARDSWORK! PROGRAM CHOICE Please choose which BoardsWork! process would best fit the needs of your nonprofit: ___ $500 BoardsWork! with board matching service for 1-2 new board members (normally $1,000) ___ $750 BoardsWork! with full day BW! governance training for 2 current board members (normally $1,500) PLEASE INCLUDE A ONE PAGE STATEMENT WITH YOUR APPLICATION FORM DESCRIBING:    What is motivating your organization to participate in this program? What are three practical governance issues your board hopes to address? Why should your organization be chosen to receive this scholarship? Please return the completed application and supplemental statement to [email protected]