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FOLMC Board Intake Form
FOLMC Board Intake Form
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
(Required)
Email
(Required)
Gender
(Required)
Woman
Man
Non-Binary
Non-Transgender (cis)
Transgender
Decline to State
Answers are taken in aggregate and not shared as individual results.
Age
(Required)
Under 18
18-29
30-44
45-64
65-74
75 and Over
Answers are taken in aggregate and not shared as individual results.
Race/Ethnicity
(Required)
African American/ African/Black
Asian/ Asian American/Pacific Islander
Caucasian/Eu rope an/White
Hispanic/Latinx
Native American/American Indian/Indigenous
Multi-Racial or Multi-Ethnic
Decline to State
Answers are taken in aggregate and not shared as individual results.
Sexual Orientation
(Required)
Asexual
Gay, Lesbian, Bisexual
Heterosexual or Straight
Decline to State
Answers are taken in aggregate and not shared as individual results.
Employment Status
(Required)
Employed
Self-Employed
Retired
Student
Decline to State
Answers are taken in aggregate and not shared as individual results.
Expertise/Experience
(Required)
Acctng/auditing/financial mgt.
Advocacy/legislative affairs
Banking/investing/financial services
Business/retail
Communication (online/written)
Digital/Web/Social Media
Education
Fundraising
Governance/Board assessment
Grant evaluation
Human Resources
Information technology (HW/SW)
Legal
Library/FOL
Marketing/promotion
Membership
Nonprofit
Prior Board experience
Prior committee experience
Prior recruiting/nominating expnce.
Program ping/implementation/ eval.
Public Relations
Real estate
Regulatory/compliance
Risk management
Strategic planning
Answers are taken in aggregate and not shared as individual results.
Affiliation
(Required)
FOLMC member
Librarian
Writer
Civic activities
Disabled
Neighborhood HOA
Neighborhood Listserv
Nonprofit
Education
Corporate
Fraternity/Sorority
Media
Small Business
Answers are taken in aggregate and not shared as individual results.
Service Region of County
(Required)
BCC (Bethesda, Chevy Chase, Potomac)
Eastern Montgomery (Burtonsville, Colesville, Sandy Spring)
Mid-County (Bell Pre, Brookeville, Glenmont, Kensington, Rockville, Aspen Hill, Wheaton, Derwood, Olney, Twinbrook)
Silver Spring
UpCounty (Boyds, Clarksburg, Mt. Airy, Damascus, Dickerson, No. Potomac, Gaithersburg, Germantown)
Answers are taken in aggregate and not shared as individual results.
Commitment Agreement
(Required)
I agree to the Annual Trustee Responsibilities and Commitment Agreement
Thank you for volunteering to serve on the FOLMC Board of Trustees. Your service is vital to FOLMC’s success! So that you get the most out of your Trustee experience, please take a moment to review the following expectations for Trustees and signify your agreement.
I understand that my Responsibilities as a Trustee are to:
● Read with a goal to understand FOLMC mission, vision, and values.
● Attend board meetings and committee meetings as outlined below.
● Determine how FOLMC carries out its mission through short- and long-range planning and
evaluation of performance and accomplishments.
● Review the annual budget, major expenditures, Form 990, and investment of funds for the effective oversight of the organization.
● Review, revise, and adopt the Executive Committee's recommendations for policies and procedures.
● Be alert to community needs that can be addressed by FOLMC’s mission, objectives, and programs.
● Assist in Fundraising, promotion and outreach, including asking my company to make an annual
contribution, identifying potential new donors, and helping to sell tickets to fundraising events.
● Serve as an active advocate for the organization within the community.
● Stay informed about FOLMC activities and finances by reading FOLMC and MCPL enews, print newsletters, and annual reports.
● Record FOLMC meetings in your calendar, RSVP to FOLMC events in a timely manner, and honor commitments.
I understand that the Term and Time Demands of a Trustee are to:
● Serve on the Board for up to three years or the balance of the unfinished term, with an option to renew for another three-year term.
● Serve a maximum of a third three-year term, pending a unanimous vote of the Board of Trustees. Terms begin on January 1.
● Actively participate (i.e. attend) in at least 75% of board meetings(four board meetings annually
on the third Wednesday of February, May, August, and November for approximately 2 hours).
● Participate on at least one (but no more than three) committees (average of four meetings per year per committee, pending the respective work agenda; dates to be scheduled as determined by committee).
● Carry out task work outside of board and committee meetings and participate actively in those meetings.
● Attend an orientation session to become familiar with the mission and activities of FOLMC as well as your role as a board member.
● Represent the FOLMC Board of Trustees by attending programs (ticketed or free) sponsored by FOLMC each year, as well as one or more programs per year that are sponsored by another organization (e.g. community festivals, town halls, and forums).
I understand that the Financial Expectations of a Trustee are to:
● Make a monetary contribution to FOLMC in an amount commensurate with the organization’s Give & Get Policy.
● Maintain current membership as a Friend of the Library.
● Actively participate in FOLMC fundraising activities (i.e., selling tickets, recruiting members, planning events, soliciting donations, etc.).
I understand that the Criteria for Nomination and Renewal are that Trustees:
● Live, work, or have a vested interest in Montgomery County, Maryland.
● Demonstrate an understanding of the cultural and ethnic diversity within Montgomery County and actively represent the interests of all communities.
● Demonstrate commitment and interest in Montgomery County Public Libraries.
I understand that without full engagement and active participation from all Trustees, the Board cannot ensure that the organization fulfills its mission. Should I be unable to participate as outlined in this Commitment Agreement, I agree to contact the Board Development & Governance Committee Chair with my concerns for guidance. Should I demonstrate continued inability to fulfill my responsibilities as a
Trustee, I will expect to be contacted by the Board President and/or the Executive Director to discuss next steps, which may potentially include a request to vacate the Trustee position.
I accept the above commitment as an understanding of my role and responsibilities as a member of the Board of Trustees.
Confidentiality Agreement
(Required)
I agree to the Confidentiality Agreement.
1. As part of the Duty of a Board Member, the Board Member hereby agrees that they will never disclose any confidential or proprietary information of FOLMC, or its subsidiaries or affiliates, to any person, firm, corporation, or other entity (other than to appropriate persons in the FOLMC organization), or use any such confidential or proprietary information for their own purpose or for the benefit of any other person, firm, corporation or other entity except FOLMC.
2. For the purpose of this Agreement, the term “confidential or proprietary information” shall mean all information about or relating to FOLMC or any subsidiary or affiliate of FOLMC which:
a) relates to specific matters such as member information, employee information, government contracts, inventory information, member lists, existing or potential members, board policies and procedures, board meeting discussions, intellectual property, bidding, pricing and credit techniques or strategies, FOLMC costs, market studies, marketing plans and strategies, financial information, and methods relating to FOLMC business, electronic or paper data, computer software programs, as they may exist from time to time, which Board member may have acquired or obtained by virtue of that position with FOLMC or any of its subsidiaries or affiliates; and
b) is known only to Board member or others in a confidential relationship with FOLMC or any of its subsidiaries or affiliates.
3. Upon resignation or other departure from the Board, Board Member agrees that they will promptly deliver to FOLMC all manuals, keys, policies, customer lists, manuals, letters, notes, notebooks, reports, and copies thereof, as well as any and all other confidential or proprietary information and any and all other materials, supplies, or equipment belonging to FOLMC that they may have in their possession or under their control.
4. Both parties agree that any provision of this Agreement that may at any time be prohibited or unenforceable by law shall be ineffective only to the extent and for the duration of such prohibition, and such un-enforceability shall not invalidate the remaining provisions of this Agreement.
5. All notices, requests, demands and other communications will be in writing and will be deemed to have been duly given if delivered or mailed, first class postage prepaid to the address listed in this form.
6. This Agreement shall be binding upon FOLMC, its successors and assigns, and upon Board Member and her/his heirs, administrators, representatives, executors, successors, and assigns.
7. Board member agrees that s/he will promptly offer his or her resignation, but no later than three (3) days, after notification by the Board that their actions have violated the provisions of this agreement.
Conflict of Interest
(Required)
I agree to the Conflict of Interest Policy.
I have received and carefully read the Conflict of Interest Policy for Board members, employees, and volunteers of FOLMC and have considered not only the literal expression of the policy, but also its intent. By signing this affirmation of compliance, I hereby affirm that I understand and comply with the Conflict of Interest Policy. I further understand that FOLMC is a charitable organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes.
Except as otherwise indicated in the FOLMC Disclosure Statement and any attachments, I hereby state that I do not, to the best of my knowledge, have any conflict of interest that may compete with or be seen as competing with the interests of FOLMC nor does any relative or business associate of mine have such an actual or potential conflict of interest.
If any situation should arise in the future which I think may involve me in a conflict of interest, I will promptly and fully disclose the circumstances to the President of the Board of Trustees or to the Executive Director, as applicable.
I further certify that the information set forth in the Disclosure Statement and any attachments is true and correct to the best of my knowledge, information, and belief.
Conflict of Interest Financial A
(Required)
No
Yes
Has the Friends contracted to purchase or lease goods, services, or property from you or from any relative or business associate?
If yes, please describe:
(Required)
Conflict of Interest Financial B
(Required)
No
Yes
Has the Friends purchased an ownership interest in or invested in a business entity owned by you or owned by any relative or business associate?
If yes, please describe:
(Required)
Conflict of Interest Financial C
(Required)
No
Yes
Has the Friends offered employment to you or to any relative or business associates other than a person who was already employed by the Friends?
If yes, please describe:
(Required)
Conflict of Interest Financial D
(Required)
No
Yes
Have you or have any relative or business associate been provided with a gift, gratuity, or favor from a person or entity which does business or seeks to do business, with the Friends?
If yes, please describe:
(Required)
Conflict of Interest Financial E
(Required)
No
Yes
Have you or any relative or business associate been gratuitously provided use of the facilities, property, or services of Friends?
If yes, please describe:
(Required)
Conflict of Interest Other A
(Required)
No
Yes
Did you obtain preferential treatment by the Friends for yourself or for any relative or business associate?
If yes, please describe:
(Required)
Conflict of Interest Other B
(Required)
No
Yes
Did you make use of confidential information obtained from the Friends for your own benefit or for the benefit of a relative, business associate, or other organization?
If yes, please describe:
(Required)
Conflict of Interest Other C
(Required)
No
Yes
Did you take advantage of an opportunity, or enable a relative, business associate or other organization to take advantage of an opportunity, which you had reason to believe would be of interest to the Friends?
If yes, please describe:
(Required)
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