CULTURAL AGENCY PROFILE

 

 

This questionnaire is used to gain information about Museums, Historical Societies and similar Cultural Agencies that petition the Board of Regents for an absolute charter.

INSTRUCTIONS
Please answer all of the questions to the best of your ability. If necessary, please feel free to add any additional information you feel will be helpful during this review process. Once completed, please send it with supporting documentation to the mailing or email address above, or with the absolute charter petition to the New York State Education Department Office of Counsel.

I.          GENERAL INFORMATION

  1. Complete Corporate Name of Organization:                                                                       
  1. Address.

P.O. Box or Street:                                                                                                            

City:                                                                                                                                  

State and Zip Code:                                                                                                           

Telephone number:  (                    )                                                                                    

E-mail address:  _______________________________________________________

  1. Contact Person.  Please supply data for a person to be contacted for further information.  Telephone number should be where he/she can be reached during normal business hours.

Name:                                                                                                                                  

Telephone:   (         )                                                                                                          

E-mail address:  _______________________________________________________

II.        GOVERNING AUTHORITY

  1. Does the organization have a legally constituted Board of Trustees?           

Yes or No

  1. Please attach a list of the names of all officers and members of the Board of Trustees, noting those who have special duties or expertise. 

List attached?               Yes or No

  1. Are updated copies of the organization's governing documents on file - that is, the Constitution or By-Laws?

Yes or No

  1. Please attach a copy of the organizations mission statement

Copy attached?           Yes or No       

  1. Does the organization formally accept and follow the Code of Ethics for Museums set by the American Alliance of Museums?

Yes or No 

  1. Please attach a list of all committees established by the Board.

List attached?               Yes or No

  
III.       STAFF AND LEADERSHIP

  1. Does your organization have a paid professional staff?

Yes or No

If yes, please attach a list showing each position, hours per week and salary.  Attach a resume for each professional staff member if your organization’s operating budget exceeds $100,000.

List attached?               Yes or No

Resumes attached?       Yes or No

If Yes, is in-service training provided for your organization's staff?

Yes or No

  1. Does your organization use the services of any individual who assists by providing advice?  (e.g., an official of local government, a college faculty member or employee of a service organization).

Yes or No            

  1. Does the organization utilize the services of volunteers?

Yes or No

  1. Does the organization have a program (formal or informal) for training volunteers?

Yes or No 

IV.       FINANCES

  1. Is the organization tax exempt under a provision of the Internal Revenue Service (IRS) code?

Yes or No

If “Yes,” is it already on file and if not please attach a copy of the organization's IRS tax-exempt letter.  (Do not send a copy of your New York State Exempt Organization Certificate)

 

  1. Does the organization have formal financial and record maintenance policies?

Yes or No

V.        FACILITIES

  1. Does the organization own and/ or rent real property?

 

Yes or No

If No, please explain:

 

 

Is the building or structure listed on the National Register of Historic Places?

Yes or No

           If “Yes,” is it individually listed or listed as part of a district?

 

 

Is the building or structure accessible to the handicapped (for example, to a person in a wheelchair)?

Yes or No

  1. Does this space have fire, security and climatic control systems?

Yes or No

Are fire extinguishers available?

Yes or No

  1. Does the organization have an emergency/ disaster preparedness plan?

           Yes or No

            If yes, please attached?        Yes or No

 Is the building insured?

            Yes or No

  1. Are your facilities open to the public at stated hours without advanced reservations?

Yes or No

If yes, how many hours are they opened?

    
VI.       COLLECTIONS

  1. Does the organization own collections?

Yes or No 

If yes, what percentage of the collection is accessioned?  ____________ Percent

  1. Briefly describe the composition of your collection.

 

 

  1. Has the organization deaccessioned any objects from the collections in the last three years?

Yes or No

If yes, please state the reason for deaccessioning and if there were any proceeds.

 

                 

  1. Is an updated copy of the policies and procedures which govern the care and loan of objects owned by the organization and govern the acquisition and disposal of objects into and out of the organization on file?

Yes or No

If yes, does the policy state the recent deaccession rules that came into effect on June 8, 2011?

Yes or No

If no, please have these new deaccession rules added to the current collections management policy. (These rules are required before a site visit can be scheduled)

Attached? Yes or No

  1. Are collection record files duplicated and a copy kept elsewhere for security?

Yes or No

  1. Is the organization's collection insured?

Yes or No

  1. Are borrowed objects insured?

Yes or No

  1. Are collections regularly surveyed to determine the condition of objects?

Yes or No

  1. Has the organization used the services and/or consultations of outside conservators or restorers?

Yes or No

  1. What type of training do the organization's staff and/or volunteers receive in the proper handling of the collections?  Please describe.

 

 

 

VII.     PROGRAMS AND EDUCATIONAL ACTIVITIES

  1. Does the organization offer educational or public programs?

Yes or No

  1. Does the organization respond to research inquiries from the public?

Yes or No

  1. Does the organization have a program for school age (K-12) children related to the school curriculum?

Yes or No

  1. What types of special programs or activities does the organization schedule on a regular basis?

 

 

 

VIII.    PLANS AND FUTURE

  1. What goals does your organization hope to achieve in the next five years?

A.

B.

C.

D.

E.

F.

  1. What goals does your organization hope to achieve in the next ten years?

A.

B.

C.

D.

E.

F.

Thank you for completing this questionnaire. Please attach the appropriate documents and please be sure to sign and date the back of this form.

 

Please sign and date the questionnaire when you complete it.

           
Signature of Preparer:                                                                                                              

Title of Preparer:                                                                                                                                  

Date:                                                                                                                                                   

 

 

 

RETURN THIS FORM TO:
Office of Cultural Education
New York State Education Department
C/o Sarah Jastremski
10A33 Cultural Education Center
Albany, NY  12230

Phone: (518) 474-5976
Email: Charters@mail.nysed.gov

 

 

Updated: October 1, 2013