Board Member Survey – Couleecap

This survey is part of the Wisconsin Department of Children and Families’ (DCF) monitoring process for organizations that receive Community Services Block Grant (CSBG) funds. DCF is required by federal law to monitor each agency once every three years. Please take a few moments to complete this survey. Your answers will not be made public and will only be used to help identify any technical assistance needs that Couleecap may have. Please contact Katie Castern, CSBG Contract Manager, with any questions at katie.castern@wisconsin.gov or (608)267-8949. Thank you for your time and for your service to your community.


A red asterisk (*) indicates required questions.

Name:*


Date:*


Officer Title (if applicable)


1. How long have you been a board member of NWCSA’s board?*
Less than 1 year
1 to 4 years
5 to 9 years
10 years or longer


2. What sector do you represent on the board? Please check:*
Public
Low-Income Individuals and Families/Consumers
Private
I'm not sure


3. If you represent low-income individuals and families, were you elected by low-income members of the community?
Yes
No
I'm not sure


4. If you represent a public official or specific group or organization do you provide regular reports about the board meetings to the person or group you represent?*
Yes
No
This does not apply to me.


5. Please check the following agency documents to which you have access and/or you have reviewed:*
Bylaws
Board Manual/Board Policies and Procedures
Personnel Policies and Procedures
Fiscal Manual
Strategic Plan


6. How often are board meetings held? *


7. Who chairs your board meetings? *


8. Are you a member of any board committees? *
Yes
No


If yes, which committee?


How frequently does this committee meet?
Monthly
Quarterly
As needed
Other


Explain "Other"


Are minutes kept for your committee‘s meetings?
Yes
No


9. Does the board perform a periodic performance review or evaluation of the executive director?*
Yes
No


If yes, did you participate in the most recent performance review?
Yes
No


10. Does the agency have directors’ and officers’ liability insurance? (This is not a requirement.) *
Yes
No
I don't know


11. Did you have a role in the development and/or review of the agency's most recent community needs assessment? *
Yes
No


If yes, please describe your role:


12. Did you review the agency’s most recent annual CSBG application?*
Yes
No


Did you have a role in developing the workplan and program goals that are outlined in the CSBG application?
Yes
No


If yes, please describe your role:


13. Have you been informed of the proposed new Organizational Standards for Community Action Agencies?*
Yes
No


14. Does every board meeting include updates on the agency’s programs?*
Yes
No


15. Does every board meeting include an update on the agency’s financial status?*
Yes
No


16. Have you signed a Conflict of Interest statement within the past 2 years? *
Yes
No


17. Did you receive an orientation within your first six months as a new board member? (Org. Standard 5.7)*
Yes
No


If yes, from whom?


18. Have you participated in the review of the following?*
Cost allocation plan
Indirect cost proposal (if your agency has one)
IRS Form 990
Annual audit
Travel policy
Executive director’s contract/compensation package
Annual agency budget


19. Did you receive training to understand financial reports and the audit? *
Yes
No


If yes, who provided the training?
CFO/finance director
Executive director
Finance or audit committee
Board of directors
Other


Explain "Other"


20. Who is responsible for signing agency checks?*


21. Who approves the executive director’s expenses?*


22. Are there any legal actions pending against the agency?*
Yes
No
I don't know


If yes, please explain:


23. Does the board review and approve all substantial agency transactions, such as the agency borrowing money or purchasing property?*
Yes
No
I don't know


Additional comments