Name
First Name
Last Name
Organization
Title
Email
Phone
(###)
###
####
Is the above number a work or cell number?
Connection to the Quad Cities Nonprofit Sector – check all that apply
If other, please specify
If you are employed in the nonprofit sector, how many employees are in your organization?
I am not employed in the nonprofit sector
Zero employees – I’m a “staff” volunteer
1 employee
2-5 employees
6-10 employees
11-20 employees
21 to 50 employees
51 to 100 employees
101 or more employees
If you are employed in the nonprofit sector, what type of role do you have? - Check all that apply
If other, please specify
If you are employed in the nonprofit sector, how long in total have you been employed in the nonprofit sector?
I am not employed in the nonprofit sector
Less than one year
One to five years
Six to ten years
Ten to twenty years
More than twenty years
If you are employed in the nonprofit sector, what type of work does your organization do? (Many may apply, please select the ONE that fits best)
I am not employed in the nonprofit sector
Arts, Culture, and Museums
Education and Research
Health
Aging Services
Children and Family Services
Community Improvement and Development
Environment and Animals
Early Child Care and Education
Human Services
Philanthropy and Voluntarism
Workforce Development
Youth Development
Other (Please specify)
If you are a board member of one or more nonprofit organizations, please describe your experience and the types of organizations you serve.
Do you currently work or serve on the board of an organization:
Please share with us why you are interested in the Hunt and Diane Harris Center for Nonprofit Excellence at the Quad Cities Community Foundation.
Race/Ethnicity – How do you publicly self-identify? Please check all that apply.
Prefer to self describe
Gender Identity – How do you publicly self-identify?
Prefer to self describe
Ability Status – How do you publicly self-identify?
Prefer to self describe
