CULTURAL AGENCY PROFILE

 

 

This questionnaire is used to gain information about Cultural Agencies that petition the Board of Regents for Certificate of Incorporations for organizations that do not own or hold collections.

INSTRUCTIONS
Please make sure that all questions get answered. If necessary, feel free to add any additional information you may find will be helpful during this review process. Once completed, please send it with supporting documentation to either the mailing or email address above, or with the certificate of incorporation petition to the New York State Education Department Office of Counsel.

I.          GENERAL INFORMATION

  1. Complete Corporate Name of Organization:                                                                       
  1. Address.  (All organizations must have a permanent mailing address.  A Post Office Box is acceptable).

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:  _______________________________________________________

  1. Which of the following best characterizes the Cultural Organization?  PLEASE CIRCLE ONLY ONE.
    1. Aquarium
    2. Archive
    3. Art Center
    4. Botanic Garden, Arboretum or Herbarium
    5. Consortium, Conference or Federation of Cultural Organization
    6. Friends Group or Support Organization.
    7. Historical Society
    8. Library with Collections
    9. Nature Center
    10. Performing Arts Center
    11. Planetarium
    12. Zoological Institution or Zoo
    13. Foundation
    14. Other type of Cultural Organization: PLEASE SPECIFY:                                                                               

II.        GOVERNING AUTHORITY

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

Yes or No

  1. Please attach copies of the organization's governing documents - that is, the Constitution or By-Laws.  These are required before Incorporation will be granted.

Copies attached?          Yes or No

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

List attached?               Yes or No

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

List attached?               Yes or No

III. MEMBERSHIP

  1. Is the organization a membership organization?

Yes or No

If no, does the organization have a subsidiary which acts as a membership group?

Yes or No

           If both of the above questions are No, skip to Section IV.

  1. In the last three years, has membership increased or decreased? 

 

  1. Describe the membership dues structure.

 

 

  1. Does the organization hold regularly scheduled membership meetings?

Yes or No

Are meetings open to the public?

Yes or No

IV.       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

  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 

V.        FINANCES

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

Yes or No or Not Yet

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

Copy attached?                        Yes or No

VI.       FACILITIES

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

Yes or No

If yes, please describe the land and/or buildings by type (school, church, historic structure or site, etc.).  Give age or date of construction, size, number of rooms, etc. of the structure(s).

 

 

 

 

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

Yes or No

  1. How the space is used (meeting room, collection storage, exhibits, office space, etc.). 

 

 

 

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

Yes or No

Are fire extinguishers available?

Yes or No

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

Yes or No

      
IX.       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?

 

 

 

 

X.        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.

 

Thank you for completing this questionnaire.

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

 

 

Revised October 1, 2013