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What is your name?
   
 
 
 
What is a good email address for you?
   
 
 
 
What is a good contact phone number for you?
   
 
 
 
What is your current employment status?
 
 
 
What is your current affiliation? (ie organization)
   
 
 
 
Are you a board member?
 
Yes
 
No
 
 
 
What are the strengths of this committee?
   
 
 
 
What are you wanting more from this committee?
   
 
 
 
What are the areas of needed improvement in this committee?
   
 
 
 
Within this committee, what are your current activities?
   
 
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