If the donor has provided their own gift agreement, please upload it here:
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When is the gift agreement needed by?
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Month
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Day
Year
Date
Fundraiser Name:
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First Name
Last Name
Submitted By:
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First Name
Last Name
Donor Legal Name:
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Donor Recognition Name:
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Donor Contact Name:
Contact Title:
Agreement Amount:
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Is this agreement supporting capital expenses?
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Yes
No
How much will support capital?
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Briefly describe the capital expense.
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Payment Year One:
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Payment Year One Date:
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Month
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Day
Year
Date
Payment Year Two:
Payment Year Two Date:
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Month
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Day
Year
Date
Payment Year Three:
Payment Year Three Date:
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Month
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Day
Year
Date
Payment Year Four:
Payment Year Four Date:
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Month
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Day
Year
Date
Payment Year Five:
Payment Year Five Date:
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Month
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Day
Year
Date
Gift Purpose:
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Impact Report Requirements
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Please Select
Annual
Pillar
Custom
Donor Recognition Details (other than Annual Impact Report):
Is a new fund needed?
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Yes
No
Existing SPF number:
If the gift is restricted, does the 15% Infrastructure Fee apply?
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Yes
No
Is a naming opportunity included?
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Yes
No
Declined Infrastructure Fee Documentation
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Has the opportunity been approved by the Stewardship and Donor Relations team?
Yes
No
Has any necessary Publicity been approved by the PR & Marketing Team?
Yes
No
Is the gift agreement related to entering into another agreement for goods or services?
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No
Yes
Does the gift require the exchange, purchase or services, or provision of information from Children's National (aside from standard stewardship impact reports)?
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No
Yes
Has the donor made restrictions or conditions on the gift (e.g. if the gift restricted to a specific fund, is Children's National required or obligated to do something or hold an endowment with a periodic spend/release rate)?
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No
Yes
Do these restrictions align with Children's National 's mission?
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No
Yes
Description of the restriction and/or condition of the gift:
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Does the gift require or identify naming opportunities (i.e. when the donor gives money with the condition that their name will appear in some distinguished way, such as appearing as the name of a scholarship fund or the name of a building)?
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No
Yes
Description of the naming opportunity, if applicable:
To the best of your knowledge, is the donor, a family member, or personal relation related to or associated with a vendor of Children's National or a Children's National subsidiary?
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No
Yes
Description of the company name, its status as a Children's National vendor, an by whom the interest is held:
Is the gift agreement related to or arising out of the services offered by the donor?
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No
Yes
Description of services offered by the donor that the gift is related to:
To the best of your knowledge, does the donor, a family member, or personal relation own 5% or more of a publicly-traded company or hold any equity interest valued at greater than $10,000 in a private company?
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No
Yes
Describe each instance an by whom the ownership or interest is held:
To the best of your knowledge, does the donor, a family member, or personal relation hold any equity or financial interest in any start-up companies of Children's National or Children's National subsidiaries' employees?
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No
Yes
Name of the company, the type of interest, and by whom the interest is held:
Additional documentation, if applicable:
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Additional information:
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