The document is a board self-assessment survey that asks board members to rate how much they agree or disagree with statements about their responsibilities in key areas of governance. The statements address the board's role in setting mission and strategy, overseeing programs and finances, engaging in planning, selecting new members, and ensuring legal and risk compliance. Board members are asked to check boxes to indicate their level of agreement with statements about their effectiveness in each role.

1. BOARD SELF-ASSESSMENT: How much do you Agree or Disagree with these statements? (Check one box for each statement.)
SD = Strongly Disagree; D = Disagree; A = Agree; SA = Strongly Agree; NS = Not Sure.
MISSION AND PURPOSE
 SD D  A SA  NS
The nonprofit has a clear written mission statement that reflects its purpose.
The board’s policy decisions and the nonprofit’s programs and services reflect the nonprofit’s  SD D  A SA  NS
mission.
SELECT AND SUPPORT THE CHIEF EXECUTIVE AND REVIEW HIS OR HER PERFORMANCE
The board has approved a written job description that clearly spells out the responsibilities of the  SD D  A SA  NS
nonprofit’s chief executive officer/executive director.
The board delegates all day-to-day management decisions for the nonprofit to its chief executive.  SD D  A SA  NS
The board assesses the chief executive’s performance on an annual basis.  SD D  A SA  NS
APPROVE AND MONITOR THE ORGANIZATION’S PROGRAMS AND SERVICES
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The board is knowledgeable about the nonprofit’s current programs and services.  SD D  A SA  NS
The board knows the strengths and weaknesses of each major program.  SD D  A SA  NS
The board approves an annual operating plan, monitors implementation, and makes sure that the  SD D  A SA  NS
programs are evaluated in order to measure success and impact.
RAISE MONEY
The board understands the fundraising strategy for the nonprofit.  SD D  A SA  NS
The board has a clear policy on the individual board member’s responsibility to raise money.  SD D  A SA  NS
ENSURE EFFECTIVE FISCAL MANAGEMENT
The board discusses thoroughly the annual operating budget of the nonprofit before approving it.  SD D  A SA  NS
The board receives financial reports on a regular basis that are understandable, accurate, and  SD D  A SA  NS
timely.
The board requires an annual audit and considers all recommendations made in the independent  SD D  A SA  NS
auditor’s report and management letter.
ENGAGE IN STRATEGIC PLANNING
The board focuses most of its attention on long-term, significant policy issues rather than day-to-  SD D  A SA  NS
day administrative matters.
The board has a strategic vision of how the nonprofit should be evolving over the next three to  SD D  A SA  NS
five years.
CAREFULLY SELECT AND ORIENT NEW BOARD MEMBERS
The board has an effective process to identify the qualifications and expertise that new board  SD D  A SA  NS
members should bring to the nonprofit.
The board cultivates and recruits candidates who are representative of the community and possess  SD D  A SA  NS
the qualities needed to strengthen board composition.
The board provides new board members with a comprehensive orientation to board  SD D  A SA  NS
responsibilities, the nonprofit’s services and programs, and administrative procedures.
The board has established policies for length of board service and rotation of board members.  SD D  A SA  NS
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2. BOARD SELF-ASSESSMENT: How much do you Agree or Disagree with these statements? (Check one box for each statement.)
SD = Strongly Disagree; D = Disagree; A = Agree; SA = Strongly Agree; NS = Not Sure.
UNDERSTAND RELATIONSHIP BETWEEN BOARD AND STAFF
The respective roles of the board and staff are clearly defined and understood.  SD D  A SA  NS
A climate of mutual trust and respect exists between the board and the chief executive.  SD D  A SA  NS
The board gives the chief executive enough authority and responsibility to lead and manage the  SD D  A SA  NS
organization successfully.
The board has adopted adequate personnel policies for staff selection, training, promotion, and  SD D  A SA  NS
grievance procedures.
ENHANCE THE ORGANIZATION’S PUBLIC IMAGE
Board members promote a positive image of the organization in the community.  SD D  A SA  NS
The board understands who can serve as the official spokesperson for the organization.  SD D  A SA  NS
MEETING EFFICIENCY
Board members are familiar with the bylaws.  SD D  A SA  NS
Board meetings are interesting, well run and start on time.  SD D  A SA  NS
Board members receive clear agendas and supporting written material sufficiently prior to board  SD D  A SA  NS
and committee meetings.
Board members respect each other’s opinions, and participate in board discussions.  SD D  A SA  NS
Board minutes are accurate, timely and easy to understand.  SD D  A SA  NS
Board members have adequate opportunities to discuss issues and ask questions.  SD D  A SA  NS
BOARD COMMITTEES
The board has the right number and kind of committees to perform its work effectively.  SD D  A SA  NS
Committee assignments reflect the interests, experience, and skills of the board members.  SD D  A SA  NS
Each committee has a written responsibility description and an annual plan of work.  SD D  A SA  NS
ENSURE LEGAL COMPLIANCE AND SOUND RISK MANAGEMENT POLICIES
The board annually reviews the operations of the nonprofit to make sure it complies with all the  SD D  A SA  NS
requirements imposed on a federally qualified health center or look-alike.
The board ensures nonprofit compliance with all applicable federal, state and local laws and  SD D  A SA  NS
regulations.
The board has an adequate amount of liability insurance to cover board members and staff in the  SD D  A SA  NS
event of lawsuits filed against them as individuals or against the nonprofit as a whole.
Any Additional Comments?
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