NSBE Chapter Visit Request - National Society of Black Engineers

Chapter Visit Request

Name*:
Location*:
Chapter Leadership Position, if any*:
Phone Number*:	() -Second partThird part
Email address*:
Geographical Region*:
Choose up to 5 potential visitors (use "ctrl" for multiple selections)*:
Dates Requested (list top 3 dates):
1):	Date and time
2):	Date and time
3):	Date and time
Would you classify your chapter as*:
What is the main reason you are requesting a chapter visit AND how would a visit from a NSBE leader address your chapter's needs?:

What are the 3 greatest strengths of your chapter:

What are your chapter's 3 greatest challenges or weaknesses?:

How would you rate your NSBE chapter in the following areas? (Consider 1 as not successful and 5 as masters of this area.)
Member Recruitment*:
Member Participation*:
Choosing programs*:
Implementing programming:
Fundraising*:
Getting members to Regional & National meetings*:
Comments:
Please list below the programs your chapter currently offers.*:

What new programs, projects, or campaigns do you wish to pursue this year?*: