Consultant Information Form

Salutation:

* First Name:

M.I.

* Last Name:

* Date:

* Professional Job Title:

* Consulting Agency/Company Name

* Address:

* City:

* State:

* Zip:

Additional Address Information:

* Telephone Number:

* E-Mail Address:

Website (if applicable):

* Race/Ethnicity:

If AN or AI, are you an enrolled member?

Yes

No

If American Indian (AI) please indicate tribe(s):

Consultant Skills Inventory

Areas of expertise: Please indicate the top five areas in whcih you would like to be listed as a consultant in the FNDI data bank. For each area, pelase rate your experience/skill level on a scale of (1) to (5).

(1) = lowest level of experience/skill (5) = highest level of experience/skill

Financial Management

	1	2	3	4	5	Comment
501(c)(3) Determination Process
990 Completion
Accounting/Financial Reporting
Auditng/Controls
Asset Management
Bookkeeping. Proficient in which accounting/bookkeeping software?
Budgeting
Charitable Solicitation Registration
Human Resource/Benefits Management
State and Federal Payroll Taxes
Risk Analysis
Travel Policy Development

Resource Generation/Development

	1	2	3	4	5	Comment
Customer Service
Direct Mail
Fundraising. How long?
Grant Research
Proposal Writing Process
Program Design
Program Policy Development
Mission Fulfillment
Mission/Vision Statement Development
Revenue Genreation
Strategic Planning

Evaluation

Communications

Cultural Competency

Governance

	1	2	3	4	5	Comment
Articles of Incorporation
Board Development
Bylaw Development
Committee Development/Management
Governance
Meeting Protocol
Policy Development
Strategic Planning

Human Capacity

	1	2	3	4	5	Comment
Human Resource Policy Development
Recruiting Board of Directors
Recruiting Executive Level Staff
Recruiting Administrative and Program Staff
Recruiting Volunteer Staff
Engaging Volunteers

Data Management

Management

Technology

	1	2	3	4	5	Comment
Microsoft Word
Microsoft Excel
Microsoft Access
Microsoft PowerPoint
Operating Systems
Server/Network Administration
Other Proprietary Software?

Technical Assistance

	1	2	3	4	5	Comment
Agriculture
Construction Management
Implementation of Federal and State Regulations and/or Mandates (i.e. Clean Water Act, etc.) Please list specific expertise.
Irrigation
Livestock

Training

	1	2	3	4	5	Comment
Asset Management
Grant Research and Writing PRocess
Financial Literacy
Management and/or Leadership Training
Mentoring. For how long and in what capacity?

Experience working with specific Native communitites or organizations:

Experience providing capacity building assistance to community-based organizations:

* Consulting rate per hour:

* Are expenses included in rate listed?

Yes

No

Please provide a current resume that reflects the areas of expertise you have identified above and that contains the names and addresses for three references that you have worked with during the past three years. A FNDI screener will check your references, focusing on the areas of expertise that you indicated. Please attach your resume and references below.

If you are unable to attach your resume or list of references, please submit them:

   By e-mail to kcraven@firstnations.org
   By fax to 303-774-7836
   By postal mail to:
             First Nations Development Institute
             703 Third Ave Ste B
             Longmont, CO 80501

Please attach your resume

Please attach your list of references.

* Indicates Response Required

African American	Alaska Native (AN)
American Indian (AI)	Asian American
Caucasian	Hispanic/Latino
Native Hawaiian	Other Pacific Islander
Other

	1	2	3	4	5	Comment
Abiility to Measure Fulfillment of Organization Objectives
Data Driven Decision-Making
Evaluation Report Writing

	1	2	3	4	5	Comment
Graphic Design
Marketing
Public Speaking
Writing (i.e. internal, external communications

	1	2	3	4	5	Comment
Community Development
Traditional Knowledge
Abitility to speak and/or write in language other than English. Please list language(s).