Pre Survey - Board Benchmarking

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Pre Survey Form

How did you hear about our surveys?*

About You

Your Name*

Your Title*

Your Email*

Your Email* Confirm Email*

Your Mobile*

About Your Organisation

Your full company name*

Location of your head office*

Which of the following categories best describes your company?*

What industry is your organisation in?*

What is your organisation's annual turnover?

Please upload your organisation's logo that you would like included in the survey and on the report

Drop files here or

Accepted file types: jpg, jpeg, png, Max. file size: 50 MB, Max. files: 1.

Survey terminology

What is the correct description of your board?*

Other*

What is the correct description of your Chair?*

Other*

What is the correct description of your directors?*

Other*

What is the correct description of your CEO?*

Other

What is the correct description of your committees of your Board?*

Other

Information about your board and directors

Does your board have committees?*

Yes (any standard committee questions will be included in the survey)

No (any standard committee questions will be removed from the survey)

Number of directors to be invited to complete the survey*

Did you purchase as an optional extra for the survey to be sent to executives?*

Yes

No

Number of executives to be invited to complete the survey*

Number of directors to be invited to complete the surveys*

Number of executives to be invited to complete the surveys*

Name of your Chair*

List the names and email addresses of the directors who you want to complete the survey (list one per line)

List the names and email addresses of the executives who you want to complete the survey (list one per line)

List the names and email addresses of the directors who you want to complete the surveys (list one per line)

List the names and email addresses of the executives who you want to complete the survey(s) (list one per line)

Did you purchase a survey Module as an optional extra?*

No

Yes - Director Effectiveness Module ONLY

Yes - Committee Effectiveness Module ONLY

Yes - Director and Committee Effectiveness Modules

Did you purchase a survey Module as an optional extra?*

No

Yes - Committee Effectiveness Module

Who should complete the Director Effectiveness Module?

Directors ONLY

Directors and Executives

Who should complete the Committee Effectiveness Module?

Directors ONLY

Directors and Executives

Who should complete the Committee Effectiveness Module?

Directors ONLY

Directors and Executives

For the Committee Effectiveness Module, please list the board committee names to be assessed (one per line)

Who should complete the Director Effectiveness Survey?

Directors ONLY

Directors and Executives (Executives rate and provide comments in relation to each director)

Directors and Executives (Executives provide comments ONLY in relation to each director)

About your Survey

What date would you like your Board Effectiveness Survey launched?

Note: Must be at least 7 business days after the date you complete this form.

What date would you like your Director Effectiveness Survey launched?

Note: Must be at least 7 business days after the date you complete this form.

What date would you like your Board Effectiveness Survey closed?

Note: Must be at least 5 business days after survey launch date.

What date would you like your Director Effectiveness Survey closed?

Note: Must be at least 5 business days after survey launch date.

Which group would you like your organisation to be benchmarked against?*

Name of the Chair or other person nominated to be provided with the confidential Report(s). Please note the report(s) will be provided within 7 business days of the survey close date*

What is their email address*

What is their email address* Confirm their email address*

What is their phone number*

Post Survey

Would you like to discuss the options for obtaining some post survey professional advice in interpreting and acting on the survey results, presenting them to the board, etc.?*

Which Board Advisory Partner would you like to provide any additional advice?

Who should we contact about providing some post survey advice?*

Other*

Terms & Conditions

Information Correct Terms*

I certify that the information I have provided is correct.

Agree Terms*

I have read and agree to the other terms and conditions.

Misuse Terms*

I agree that our organisation will not misuse any of the copyright or intellectual property in the surveys and reports provided.

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