Building a High-Performance Fundraising Culture Applications must be received by January 15, 2015. Completed applications may be sent by:    Mail to: Professional Development, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 Email to: [email protected] Fax to: 314-935-8511 Questions about the program or the application process? Please contact Barry Rosenberg at [email protected] or 314-935-5504. _________________________________________________________________________________________________________ NAME _________________________________________________________________________________________________________ TITLE ORGANIZATION _________________________________________________________________________________________________________ STREET ADDRESS _________________________________________________________________________________________________________ CITY STATE ZIP _________________________________________________________________________________________________________ PHONE E-MAIL _________________________________________________________________________________________________________ NAME OF BOARD CHAIR Please check if this person has Expressed support for your participation in the series Indicated willingness to attend the 3/27/15 session _________________________________________________________________________________________________________ NAME OF PRIMARY FUNDRAISING STAFF PERSON TITLE _________________________________________________________________________________________________________ ORGANIZATION’S TOTAL ANNUAL REVENUE (ALL SOURCES) AVERAGE ANNUAL PHILANTHROPIC REVENUE (EXCLUSIVE OF CONTRACTS, UNITED WAY OR OTHER FEDERATED CAMPAIGNS) Employment History. Please list your last three positions. _________________________________________________________________________________________________________ TITLE ORGANIZATION _________________________________________________________________________________________________________ DATES _________________________________________________________________________________________________________ TITLE ORGANIZATION _________________________________________________________________________________________________________ DATES _________________________________________________________________________________________________________ TITLE ORGANIZATION _________________________________________________________________________________________________________ DATES