Candidate Name *

Candidate Name

First Name

Last Name

Name of Board Sponsor *

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Interviewer *

Date of Meeting *

Date of Meeting

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Ease of Contact *

Was it hard to schedule a meeting / conversation with the Candidate?

Yes

Candidate Potential (PROS) *

How do you see the Candidate contributing to the Board? Please include specific deliverables discussed with the candidate.

Concerns (CONS) *

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Summary of Meeting with Candidate *

Recommendation Determination *

Would you recommend that the Candidate continue onto the next step for review, towards an appointment?

Yes

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Other Comments

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