CICF Board Survey

Name:

First Name

Last Name

Preferred full name for tent card:

Company:

Job title:

Birth date (mm/dd/yyyy)

Business address:

City

State/Province

Zip/Postal

Country

Preferred phone:

Preferred email:

Home address:

City

State/Province

Zip/Postal

Country

Assistant's name:

Assistant's email:

Assistant's phone:

Include assistant on all board and/or committee correspondence?

Yes

No

DEMOGRAPHIC INFORMATION

All questions in this section are optional.

Select the race/ethnicity options with which you mostly closely align. Select all that apply.

Asian/Asian American

Black/African-American

Hispanic/Latinx

Multi-Racial

Native American/American Indian/Alaska Native

Native Hawaiian/Pacific Islander

White

Prefer not to respond

Other (please specify)Other (please specify)

Select the following disability characteristics with which you identify. Select all that apply.

Intellectual disability

Learning disability

Neurodivergent

Physical disability

No disability

Prefer not to respond

Other (please specify)Other (please specify)

If you require special accommodations for board meetings, please describe. Let us know if you would like us to contact you to discuss further.

Select the following gender identity with which you identify.

What are your preferred pronouns?

Select the following sexual orientation with which you identify.

LGBTQ+ (please specify)

Straight

Prefer not to respond

Other (please specify)Other (please specify)

Select the following religious affiliates with which you identify. Select all that apply.

PROFESSION/SKILLS

Please select the following professional skills that you may have. Select all that apply.

COMMITTEE AREAS OF INTEREST

(This does not automatically volunteer you for a committee; we are in the process of fine-tuning our committees and will provide you with more information about each committee in which you express interest. Please note that it is expected that each Director serve on one or more committees.)

GEOGRAPHIC AREAS OF INTEREST

Select the following geographic areas in which you have a particular interest. Select all that apply.

Marion County

Particular Area of Marion County (e.g., Center Township, Pike Township, Speedway, Beech Grove); please specify:Particular Area of Marion County (e.g., Center Township, Pike Township, Speedway, Beech Grove); please specify:

Hamilton County

Particular Area of Hamilton County (e.g., Fishers, Arcadia, Sheridan, Noblesville); please specify:Particular Area of Hamilton County (e.g., Fishers, Arcadia, Sheridan, Noblesville); please specify:

Central Indiana Region (Marion County and the donut counties)

Indiana (statewide)

No preference

PHILANTHROPIC AREAS OF INTEREST

Select the following philanthropic areas in which you have interest. Please select no more than 5-10.

PHILANTHROPIC COLLABORATIVE FUNDS & OPTIONS

For my own individual, family, or corporate philanthropy, I am interested in learning more about (optional):

Select all that apply.

Unrestricted Giving: giving to the area of greatest need via The Indianapolis Foundation’s and/or Hamilton County Community Foundation’s unrestricted endowment funds. Currently being matched 2(LEI):1(Donor) by the Lilly Endowment’s GIFT Initiative

Donor-Advised Fund: create a DAF to organize your philanthropy and make grants to the organizations and causes you care about with the assistance of our Effective Philanthropy Team

Corporate-Advised Fund: create a corporate donor-advised fund to organize your business’ philanthropy and engage employees with the assistance of our Effective Philanthropy Team

Planned Giving: create a fund to establish your philanthropic legacy in perpetuity as part of your estate plan through a gift in your will, beneficiary designation, charitable gift annuity, or charitable trust

Scholarship Fund: create a fund to benefit students pursuing post-secondary education (2- or 4- year degree programs; trade, technical or vocational school; graduate school; etc.)

IMPACT Account: create a fund through which you can make loans and equity investments (i.e., impact investments) to social enterprises, including for-profit organizations with a charitable purpose

Initiative Giving: give to The Indianapolis Foundation’s and/or Hamilton County Community Foundation’s specific initiatives that align with your areas of interest. Some areas are being matched 1:1 by the Lilly Endowment’s GIFT Initiative

I already have one or more funds with the Philanthropic Collaborative.

I have already included one or more entities at the Philanthropic Collaborative in my estate plan.