Local Community Engagement Survey

Name*

Position/Title*

Location*

Do you currently or have you served within the past 5 years on the board of a Nonprofit/Charitable, Civic or Governmental Organization ?*

Ex: Boy Scouts of America, United Way of Central Al, etc

Yes
No

List the organization(s) name, type of organization, position held, and indicate whether your service is Current or Past.

Examples:

Organization: United Way of Central Alabama

Type: Non-Profit/Charitable, Chamber, Beverage Association, etc

Position: Board Chair

Mission: Women's Homeless Shelter

To enter more than one organization, hit the (+) button to add additional rows.

Organization Name	Organization Type	Position Held	Location	Mission of Organization

Please list any Civic or Community interests that you are passionate about

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Local Community Engagement Survey