Executive Leaders Circle Application – Obici Name(Required) First Last Professional Title(Required) Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Your OrganizationName(Required) Mission(Required)Does your organization do work in or provide services within any of the following areas?(Required)City of FranklinCity of SuffolkIsle of Wight CountySouthampton CountySurry CountySussex CountyGates CountyOtherIf Other, which area does your organization provide work or services? Annual operating budget(Required) Number of board members(Required) Number of paid staff(Required) Number of volunteers(Required)Is your position….(Required)Full TimePart TimeIf part-time, how many hours a week do you work?Less than 16 hours/weekBetween 16-32 hours/weekMore than 32 hours/weekExperienceNumber of years in the nonprofit sector(Required)Number of years in current position(Required)Number of years with current organizationDo you currently supervise staff?(Required) Yes No If so, how many?Do you currently have budgetary responsibilities?(Required) Yes No If so, describe your responsibilities:Why You Are InterestedWhy are you interested in participating in a Leadership Circle?(Required)What do you hope to gain?(Required)
