Donor Advised Fund Request Form

Donor Advised Fund Request Form

If you hold a Midland Area Community Foundation donor advised fund (DAF), fill this form out to initiate a grant from your fund.
Name*

First NameLast Name
Your Email*
Name of your fund*
Organization to receive grant*
Dollar Amount of Grant ($100 minimum)*
Special Purpose of Grant? (If different from general operating expenses)
Have you recommended a grant to this organization before?

YesNo
I prefer that the identity of the fund from which this grant is being made......*

be disclosednot be disclosed
Nonprofit organization information

Complete this section only if: this is the first donation to this organization from your fund, or the donation must be mailed to an alternate address.
Organization's Federal Tax ID Number
Street Address of Organization
City of Organization
State of Organization
Zip of Organization
Name of Contact Person
Phone Number of Organization
By clicking on the "submit" button below, I acknowledge and agree to the following:

1. I understand that distributions from the fund are subject to approval by the Board of Trustees of the Foundation. I understand that distributions will not be made until such approval has been granted.

2. My grant recommendation will not result in the payment of any pledge or other financial obligation and neither I nor members of my family will receive any goods, services or other benefits as a result of this grant, including, but not limited to tickets for special events and other tangible benefits.

3. I agree to indemnify the Community Foundation and its Trustees and staff from any tax or penalty imposed on them if my recommendations result in a violation of the provisions of the Pension Protection Act of 2006.
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Donor Advised Fund Request Form

Nonprofit organization information