Bae Membership Profile

Last Name:
First Name:
Organization:
Address:
City:
State:
Zip:
Phone Number:
Office Number:
Cell Number:
Fax Number:
Email Address:

About Your Organization
	Advocacy
	Arts or culture
	Child care or early education
	Child welfare
	Community organizing
	Disability services
	Education
	Employment and training
	Family support
	Food or nutrition
	HIV and AIDS
	Homeless services
	Housing
	Immigrant services
	Legal services
	Mental health
	Senior services
	Substance abuse
	Youth services
	NONE OF THE ABOVE

1. About how many clients does your organization serve in a year?
	None (not a direct service provider)
	Less than 100
	101 to 500
	501 to 1,000
	1,001 to 2,000
	2,001 to 5,000
	5,001 to 10,000
	10,001 to 20,000
	20,001 to 50,000
	More than 50,000

2. About how many employees does your organization have? (include both full and part-time employees)
	Less than 20
	51 to 100
	101 to 200
	201 to 500
	501 to 1,000
	More than 1,000

3. What is your organization's annual operating budget?
	Less than $500,000
	$500,000 to $1,000,000
	$1,000,001 to $2,000,000
	$2,000,001 to $5,000,000
	$5,000,001 to 10,000,000
	$10,000,001 to $25,000,000
	$25,000,001 to $50,000,000
	$50,000,001 to $100,000,000

4. Does your organization serve...
	Only areas within New York City
	Some areas within New York City, some areas outside the city
	Only areas outside of New York City; Specify:

5. Which boroughs do you serve? Provide additional detail if you serve specific communities (CD's or neighborhoods) but not the entire borough.
	Bronx Detail:
	Brooklyn Detail:
	Manhattan Detail:
	Queens Detail:
	Staten Island Detail:

6. Do you or your organization belong to any of the following? (Check all that apply)
	Black Equity Alliance
	Catholic Charities, Archdiocese of New York
	Catholic Charities, Diocese of Brooklyn and Queens
	Council of Family and Child-Caring Agencies
	Council of Senior Centers and Services
	Day Care Council
	Employment and Training Coalition
	Federation of Protestant Welfare Agencies
	Hispanic Federation
	Homeless Services Council of New York City
	Interagency Council of Mental Retardation Agencies
	Neighborhood and Family Services Coalition
	New York AIDS Coalition
	New York Immigration Coalition
	Nonprofit Coordinating Committee of New York
	Supportive Housing Network
	The Coalition of Behavioral Health Agencies
	UJA - Federation of New York
	United Neighborhood Houses
	United Way of New York City
	Other (please Specify)

7. Does your agency serve any of the following 'high need' community districts? (Check all that apply)
	Brownsville, Ocean Park 42.7
	Morrisania, Crotona Park 45.6
	Bedford Stuyvesant 35.1
	East Tremont, Belmont 45.6
	Central Harlem 36.6
	East New York, Starrett City 33.2
	Highbridge, Concourse 35.7
	East Harlem 36.9
	Melrose, Mott Haven 45.7
	University Heights, Fordham 41.4
	Hunts Point, Longwood 45
	Bedford Park, Norwood 33
	Manhattanville, Hamilton Hgts. 31.7
	Williamsburg, Greenpoint 34.7
	Huntspoint, Longwood 45

About You
1. Which of the following best describes your title or position in the organization?
	Executive Director, President, or CEO
	Vice President or Deputy Director
	Chief operations officer
	Chief financial officer
	Program Director
	Other (please Specify)

2. About how many years have you worked for your current organization?
	Less than 1 year
	1 to 2 years
	2 to 5 years
	5 to 10 years
	10 to 20 years
	More than 20 years

3. Is there anything that would hinder you from attending BAE meetings or events? What meeting time(s) is best for you?

4. Are you currently serving on the Board of any organization? Please list and note if you serve as an officer.

5. List any affiliations you may have that will be helpful to BAE?

6. What committees do you currently serve on within BAE? Do you have any particularly issue (s) that BAE should be aware of?

7. What committees do you currently serve on outside of BAE?

8. Do you have any hobbies or personal interests that might further the mission of BAE?

Comments and Special Interests: