Executive Leaders Circle Application - Harvest Foundation

Name*

First Last

Professional Title*

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Your Organization

Name*

Mission*

Does your organization do work in or provide services within the Harvest Foundation footprint?*

Annual operating budget*

Number of board members*

Number of paid staff*

Number of volunteers*

Is your position....*

If part-time, how many hours a week do you work?

Number of years in the nonprofit sector*

Number of years in current position*

Number of years with current organization

Do you currently supervise staff?*

If so, how many?

Do you currently have budgetary responsibilities?*

If so, describe your responsibilities:

Why are you interested in participating in a Leadership Circle?*

What do you hope to gain?*