Organization Name:

Address:

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Person Completing Form:

Job Title:

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About Your Organization About Your Organization

Mission:

Please briefly describe your organization’s programs/services:

Please describe your agency in terms of its current stage of development (select one): Please describe your agency in terms of its current stage of development (select one):Start upGrowthEstablishedUndergoing Important TransitionCrisis

Please enter the number of employees at your organization:

Annual Operating Budget:

Regions served by your organization (check all that apply): Regions served by your organization (check all that apply): Cuyahoga County Lorain County Summit /Portage/Stark Tuscarawas Contries Geauga County Lake/Ashtabula Countries Medina County

Please indicate which BVU services your organization is seeking (check all that apply): Please indicate which BVU services your organization is seeking (check all that apply): Referral of board or committee members Referral of pro bono consultants for operational issues Referral of direct service volunteers Training/development for board Training/development for senior staff

Please explain further your request for services from BVU:

Thank you for completing this request for services. Someone from BVU will be in touch shortly to discuss next steps. Thank you for completing this request for services. Someone from BVU will be in touch shortly to discuss next steps.