Please fill out each section of the enrollment form as fully as possible.
Once you've completed a section, click the Next button on each form section to go to the next one.
You will be able to go back and edit your information before submitting the final form.

Basic Information

Please select your agency name from from the dropdown list. If your agency is not listed here, please select "Other" from the bottom of the list and add your agencies name to the "Other" field.

Name of Nonprofit *

Other

Physical Address *

City *

State

Zip *

Is your mailing address the same?
Yes No

Mailing Address *

City *

State

Zip *

Website * (Use format www.mysite.com or mysite.com and DO NOT include the http://)

Employee Identification Number (EIN) *

Founding Year (e.g. 2017) *

Annual Budget *

Number of Volunteer Staff *

Number of Paid Staff *

Logo

Description

Mission Statement *

Vision Statement

Current Initiatives *
Please list 2-3 key efforts or programs you are working on currently.

In order of priority, please select up to 5 of your organization's top service areas.

Service Area *

List any additional Service Areas not listed above that you'd like us to consider including with your agency profile.

Board Details

Local Governing Board
Do you have a local governing board? *
Yes No

Local Advisory Board
Do you have a local advisory board? *
Yes No

Number of Current Board Members *

Minimum required Board Size *

Maximum Allowed Board Size *

Length of Board Member’s Term (in years) *

Number of Consecutive Terms a Board Member Can Serve *

Board Meeting Frequency *

Board Rotation Start *

Additional Comments

Anticipated Number of Board Positions *

Board Skills Desired

Skill *

List of Board Member Expectations *

Board Committees

Name of Committee *

Meeting Frequency *

MLP Relationship

Past Participation in Class Engagement Day *
Never
1 Time
2-3 Times
4-5 Times
5+ Times

Year(s) Previously Participated

Names of Current Board Members who are MLP Graduates
Full names separated by commas

Names of Past Board Members who are MLP Graduates
Full names separated by commas

Contacts

CEO/ED Contact

First Name *

Last Name *

Phone *

Ext

Email *

Agency Alternate Contact

First Name

Last Name

Phone

Ext

Board Contact

First Name *

Last Name *

Position *

Phone *

Ext

Email *

Review and Submit

We recommend you review your enrollment form by clicking on each of the section tabs.

Once you are satisfied with what has been entered, please complete the fields below and click Submit.

I certify that the information I have entered into this enrollment form is correct and complete.

Name *

Position *

Contact Phone *

Contact Email *