Donor Advised Fund Grant Request Form
I understand that this is a recommendation only, and that the Foundation's Board of Directors has sole discretion for grants made from the fund.
Donor Advised Fund Name
Organization Name for proposed grant:
Address:
City:
State:
Zipcode:
Date of request:
Telephone:
Email:
Amount of proposed grant:
Purpose of grant request:
Printed Name of Donor/Advisor(s):
I attest that the recommendation(s) do/does not represent payment of a pledge or other personal financial obligation on behalf of the fund representative(s), family members or businesses they control and that no tangible benefit, goods or services, such as membership, dinners, tickets, etc. were or will be received by any individual or entities connected with the Fund (described above). I also understand no grants, loans, compensation or similar payments can be made to donors, advisors or related parties.
Submit My Request
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