OUTSIDE BOARD REPRESENTATIVE QUESTIONNAIRE

1.  Full Name of Agency:
2.  Name of Current JLH Board Representative:
3.  How often does this board/council meet? (monthly, bimonthly, quarterly)
4.  What day of the week and time of day does this board/council meet?
5.  Approximately how many hours are spent at the meeting?
6.  Any additional time spent fulfilling board/council responsibilities? (Please be specific.)

7.  What is the purpose/focus of the board/council?
8.  Have you been asked to give money?  If yes, please specify the nature of the request (lunches, administrative costs, miscellaneous items) and the amount.

9.  Please describe this agency’s current goals and objectives, both programmatic and financial.  If the agency has a mission statement, please state it here.

10.  What do you see as this agency’s strengths and/or weaknesses in accomplishing its mission?
11.  Do you see any future opportunities for collaborative projects between JLH and this agency?  If so, please describe any such possibilities.

12.  Would you recommend the JLH continue to support this agency with an Outside Board Representative?  Please explain why or why not.