The ExecConnect Application for services (ECA) consists of the following components, which
should be submitted in the order listed below. This checklist is provided to help ensure a
complete proposal, and does not need to be submitted with the proposal.

Section I: Cover Letter (one page)
Include the purpose of the requested services and a brief description of how the request
fits with ExecConnect’s mission and priorities.

Section II: Summary Sheet Form
Use the 2-page template provided.

Section III: Narrative
a) Formatting: Use 12-point font with 1-inch margins and include the HEADING
provided for each question. It is not necessary to repeat the text of the questions.
b) Page Limit: 4-page limit. This includes narrative question, #11.
Narrative Questions
1. Organization Background
2. Goals
3. Current Programs
4. Program or Project Requests Only
5. Evaluation
6. Collaboration
7. Inclusiveness
8. Board/Governance
9. Volunteers
10. Planning
11. Optional

Section IV: Attachments
If you omit any of the required attachments, provide an explanation as to why.
Note: Some incomplete proposal will not be accepted, regardless of an explanation.
Financial Attachments
1(a). Organization budget
1(b). Program or project budget, if applicable
2. Current (year-to-date) financial statements
3. Year-end financial statement of previous year
4. Major contributors
5. In-kind contributions
Explanation of items in financial attachments, if applicable
Other Attachments
6. Board of directors list
7. Proof of IRS federal status, dated within the last five years
8. Key staff
9. Annual report, if available
10. Evaluation results, if available: Provide the organization’s most recent evaluation results.
Thank you for your time and effort in completing this application.
SUMMARY SHEET FORM
Legal Name of Organization:
Mailing Address (and Physical Address if it is different and not confidential):
Phone:
Fax:
Website:
Organization Email Address:
Name of CEO or Executive Director:
Phone:
Email:
Application Contact & Title (if not the CEO or Executive Director):
Phone:
Email:
Organization Information
Year Founded:
Mission Statement:
Geographic Area Served (specific to this proposal):
EIN:
Financial Information
Budget numbers should match the numbers presented in Attachments 1(a) & (b).
Organization’s Current Budget for Fiscal Year Ending:
Income:
___/___/___
__
Expenses:
AND, if other than a general operating request,
Program or Project Budget:
Income:
Dates: from:
__/__/__
_
to:
__/__/__
Expenses:
By signing below, I certify that the information contained in this application is true and correct to the best of my
knowledge.
CEO/Executive Director
Date
YOUR BINDING AGREEMENT
Please review the following binding terms carefully and do not apply if you do not agree to
all of them. These terms have important legal implications and you should get legal advice
before agreeing to them. By submitting an application you agree to be bound by these terms.
No Client Relationship
No contract or client relationship, whether pro bono or otherwise, is or will be established
between you and the Board or any of its members or their respective firms. Advisory services
from the Board are for general purposes only and are not intended to constitute an y specific
advice of any type (legal, accounting, tax or otherwise) or to serve as a substitute for advice
from a qualified authority who you should hire.
You and a Board member may later determine to establish a client/advisor relationship but
that relationship must be created by a written agreement executed by both you and that Board
member. No such client relationship will create or be deemed to create a client relationship
between you and the Board or between you and any other Board member.
No Attorney-Client Protections
You need to pay special attention to the implications of the fact that no attorney-client
relationship (pro bono or otherwise) exists between you and any Board member that is an
attorney. An attorney-client relationship creates special duties and protections for the client’s
benefit, including without limitation the attorney-client privilege that protects information
given to the attorney from disclosure by that attorney. As no attorney-client relationship is
established in connection with the Board’s advisory services, those protections will not apply
to you. Thus and for example, information you provide to an attorney member of the Board,
whether in this application or in consultation, is not privileged and may be used or further
disclosed, voluntarily or involuntarily, for any reason or for no reason. It is even possible that
information you supply could be reported to law enforcement authorities.
No Confidentiality
No obligation of confidentiality exists in your relationship with the Board and its members.
Any information you provide may be used or further disclosed for any or no reasons without
recourse. You always have the option to withhold information from the Board and certainly
you should never disclose anything to the Board or any Board member if you have any desire
to protect or keep that information confidential.
No Fiduciary Relationship
The directors of a corporation or the statutory managers of a limited liability company are
fiduciaries and have personal responsibility and liability to the business, including duties of
loyalty, good faith, care, and disclosure.
The Board is an advisory board only and neither the Board nor any of its members has any of
those duties or any other fiduciary duties to you.
No Warranties, No Right to Sue
You agree that you have no legal rights against any of the Board or its members, their
affiliates, successors or assigns. Advisory services by the Board and its members are made on
an AS IS basis without any warranties of any kind, express or implied, including without
limitation warranties of MERCHANTABILITY, FITNESS FOR A PARTICULAR
PURPOSE, or NON-INFRINGEMENT. You further agree that:
- you and no one claiming under or through you will threaten or institute any action,
claim, lawsuit or other proceeding against the Board or its members based in whole or in
part on your participation in the Advisory Board;
- if you or anyone claiming under or through you threatens or brings any such action,
claim, lawsuit or other proceeding against the Board or any of its members that you will
reimburse any and all of them for their reasonable attorney fees and court costs incurred;
and
- this agreement is binding on your successors, heirs and assigns and benefits the
successors, heirs, and assigns of the Board and any and all of its members.
Termination of Relationship
Either you or the Board may terminate your relationship with the Board without
consequence at any time, with or without notice, for any or no reasons. Violation of Board
policies regarding contact with Board members or abuse of your allotted consultation time
are easy ways to be terminated early.
NARRATIVE
1. Organization Background:
Discuss the founding and development of the organization. Explain the original issue
and/or opportunity the organization was founded to address and how that may have
changed over time.
2. Goals:
Describe the organization’s current goals.
3. Current Programs:
Provide a brief description of the organization’s current programs. Include population
and numbers served, as well as expected results. If this request is for a specific program,
describe the organization’s other programs here. Describe the program for which you
are seeking funding in Question 4.
4. Program or Project Requests Only:
a) Provide a summary of the plan for the program or project request. Include the issue
and/or opportunity addressed, goals and objectives, activities, and timeline.
b) Explain why the organization is approaching the issue and/or opportunity in this way.
5. Evaluation:
Respond to (a) AND (b), then respond to (c) OR (d) as relates to your specific request.
a) Describe the organization’s overall approach to evaluation.
b) Describe how the organization measures success. If this is a program request,
describe how success is measured for the program that is the subject of this proposal.
Respond to (c) OR (d). This information captures results from the past:
c) For general requests: Summarize key evaluation results or findings that demonstrate
the organization’s success. Indicate the time frame for the results or findings.
d) For program or project requests: Summarize key evaluation results or findings that
demonstrate the program or project’s success. Indicate the time frame for the results
or findings.
6. Collaboration:
Describe the organization’s most significant interactions with other organizations and
efforts. For program and project requests, address this question with respect to that
program or project only.
7. Inclusiveness:
Describe how the organization strives to be inclusive in its programs, staff, board, and
volunteers, and describe the progress to date.
8. Board/Governance:
Describe the role of the board of directors in advancing the mission of the organization.
Include the key issues related to board effectiveness that are being addressed this year,
the organization’s policy regarding board terms, and the percentage of the board that
contributes financially to the organization.
9. Volunteers:
Describe how the organization involves volunteers and unpaid personnel (other than the
board of directors) within a typical 12-month time period. Include number of volunteers
and hours (if tracked by the organization).
10. Planning:
Describe the challenges and opportunities facing the organization in the next three to five
years. Additionally, describe how the organization engages in planning and describe the
focus of any current planning efforts.
11. Optional:
If there is additional information that is vital to convey in this proposal, do so here. (This
must be contained within the four-page limit.