LOB Nonprofit Organization Application

Leaders On Board

Thank you for your interest in exploring Leaders on Board for your nonprofit organization. Since January 2009, Leaders on Board has successfully matched more than 1,000 individuals with more than 200 nonprofit organizations. These individuals are committed and passionate about issues that affect our communities like domestic violence, education and health advocacy.

Your nonprofit can have access to more than 900 Leaders on Board participants who have been trained in the basics of board membership and who have expressed an interest in serving on a nonprofit board. Each participant has a completed profile that helps us connect them to the right nonprofit organizations through an Express Match or through an individual referral.

To receive individual referrals to our program participants, nonprofits must complete the following steps:

Apply for the program. Provide a copy of the bylaws. Provide a copy of the latest financial statement given to the Board of Directors. Provide a copy of the required Directors and Officers Liability Insurance. Provide a copy of the latest 990 (IRS Form)Provide a list of your current Board of Directors (as listed on the registration)Once invoiced, pay the fee.

Please email materials to Peter Callahan at Peter.Callahan@leadershipgh.org.

Once all the paperwork has been submitted and processed by our Program Director, your nonprofit begins enjoying the benefits available to our nonprofit partners.

Leaders On Board - Nonprofit Application

Company Name *

Agency Name *

Last Name *

Company Address *

Address Line 2

City *

State/Province *

Zip *

Contact Name:

Title:

Preferred Email *

Preferred Phone # *

Website:

Organization’s Mission:

Describe your primary group and/or services:

Board member responsibilities:

Describe the current process for Board Member application, selection and orientation:

Year Incorporated:

Annual Budget:

Number of Paid Staff:

Number of Volunteer Staff:

Current Board Size:

Max Board size according to bylaws:

Board Terms:

(Length, staggered, etc.)

Expected financial contribution from Board Members:

Date/Time of Board Meetings:

Location:

List of committees:

Directors & Officers Liability Insurance Provider:

We agree to carry Nonprofit Directors and Officers Liability Insurance throughout the duration of our partnership with Leadership Greater Hartford’s Leaders on Board program. Please email a copy of the declarations page to Peter.Callahan@leadershipgh.org.

Primary Group Served:

Primary Skills Sought in New Board Members:

All Requirements:

D&O Insurance

990

BOD List

Financial Statement

Application

Dues

All materials and questions can be emailed to Peter Callahan at Peter.Callahan@leadershipgh.org.