Grant Award Acknowledgment Form

Grant Award Acknowledgment Form

Please fill out all sections of this form to acknowledge the receipt of grant or major donor funds. Include the grantor's/major donor's name, the total amount received, and a brief description of the grant purpose. Thank you!
Your Name*

First NameLast Name
Work Email*
example@example.com
Additional email to carbon copy on this acknowledgement form? (ex. Arthinia)
example@example.com
Institutional Funder or Small/Mid/Major Donor?*

Major Donor
Donor Type*
Donor Name(s)
Donor-Advised Fund (DAF) Name
Total Award Amount*
Did the donor confirm the dates the funds should be used?*
Donation Start Date Start Date* Donation End Date End Date*
Did the donor restrict the funds?*
GOTVCriminal JusticeEconomic JusticeOther
Does the donor require PushBlack to submit a financial report?*
Please list the financial report dates and type of reports required by the donor*
Major Donor Verification Letter (READ NOTE BELOW)*

Award letter is ideal, but an email from the major donor/DAF with award amount works as a temporary verification. If you are providing an email verification at the moment, all award letters or email alerts from DAF (e.g. Fidelity) must be emailed to operations@pushblack.org with a cc: to Your Part-Time Controller accountants upon receipt.
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Institutional Funder