New Account / Account Revision Request
Requestor Information
Requestor Name:
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First Name
Last Name
Requestor's First Name:
Requestor's Last Name:
Requestor E-mail:
*
Send a copy of my request to a 2nd email (if applicable):
example@example.com
General Request Information
Purpose of the request:
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New Account Request (Donor Relations will determine if a gift agreement is necessary)
Gift Agreement Request ONLY (No new account will be established)
Account Revision Request
Does this gift/account request include a naming?
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Yes
No
Is there a lead/main donor ?
*
Yes
No
Donor Name:
First Name
Middle Name
Last Name
Donor Constituent ID:
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Namings
What exactly is being named?
Please include any relevant descriptors of the item or space.
Where will the funds from this gift be deposited?
An existing account held by the SIU Foundation
Please establish a new account for this gift
What is the name and number of the existing SIUF account?
Ex: CHHS Community Care and Education Center Support Fund 107898
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Type of new account:
Non-Endowed Fund
Endowed Fund
No fund needed
How will this account be funded:
Gifts from various donors
One-time gift from a single donor
Pledge
Deferred gift
Other
Please provide specific details for the the funding of this account, including but not limited to: 1) amount(s) and date(s) of planned payments, 2) length of pledge (if applicable), 3) gift type, etc.
*
If you have a completed pledge form or Statement of Intent, please upload it at the end of this form for inclusion into the gift agreement.
Is this gift anonymous?
Yes
No
Will the spouse be included as a signer?
Yes
No
Not applicable
What is the name of this new account?
New account title (old field):
Purpose and restrictions/stipulations:
This details how the funds in the account are to be spent.
Where will this account be housed?
Please Select
Agricultural, Life and Physical Sciences (CALPS)
Alumni Association
Arts and Media (CAM)
Athletics
Business & Analytics (COBA)
Chancellor's Office
Engineering (CECTM)
Enrollment Management
Foundation
Graduate School
Health and Human Sciences (CHHS)
Liberal Arts (COLA)
Library
Public Policy Institute
School of Accountancy
School of Africana and Multicultural Studies
School of Agricultural Sciences
School of Analytics, Finance and Economics
School of Anthropology, Political Science, and Sociology
School of Applied Engineering and Technology
School of Architecture
School of Art and Design
School of Automotive
School of Aviation
School of Biological Sciences
School of Chemical & Biomolecular Sciences
School of Civil, Environmental & Infrastructure Engineering
School of Communication Studies
School of Computing
School of Earth Systems & Sustainability
School of Education
School of Electrical, Computer, & Biomedical Engineering
School of Forestry and Horticulture
School of Health Sciences
School of History and Philosophy
School of Human Sciences
School of Journalism and Advertising
School of Justice and Public Safety
School of Languages and Linguistics
School of Law
School of Literature, Writing and Digital Humanities
School of Management and Marketing
School of Mathematical and Statistical Sciences
School of Mechanical, Aerospace & Materials Engineering
School of Media Arts
School of Medicine
School of Music
School of Physics and Applied Physics
School of Psychological and Behavioral Sciences
School of Theater and Dance
VC Academic Affairs & Provost
VC ADEI (Diversity)
VC Administration
VC Development Alumni Relations
VC Research
VC Student Affairs
WSIU Broadcasting
Unknown
Budget Officer, if known:
Should anyone other than the previously listed donor(s) receive account correspondence?
Yes
No
List any additional recipients here, including constituent ID (if known).
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Account Revision Requests
Account title:
Account number (if known):
Account number (if known) old field:
Why are revisions being requested?
What changes need to be made to the existing restrictions/stipulations?
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Do you have a completed pledge form or Statement of Intent for this donor/fund?
Yes
No
If yes, please upload it below. You may also upload any additional information that will help in the creation of the gift agreement.
Upload a File
Your completed pledge form or SOI will also need to be submitted separately to Kimberly Hawk, kimberh@foundation.siu.edu.
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Do you have a completed gift agreement draft?
Yes
No
If yes, please upload your completed gift agreement draft here. If you do not upload a draft, one will be drafted for you if applicable.
Browse Files
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If you have additional information, comments, or anything that you think will be helpful to us in working on your request, please add them here:
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Submission Date:
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