Select donor type One donor, two donors, organization One donor Two donors Organization

Donor Name

Advance ID for:

Donor Name

Advance ID for:

Organization legal name

Organization short name

Advance ID for:

Organization representative's name

Organization representative's title

Is this an Outright Gift or a Pledge? Outright Gift Pledge with schedule Pledge one payment

Gift Amount:

Donor to make gift by:

Payment Schedule:

(a)		on or before
(b)		on or before
(c)		on or before
(d)		on or before
(e)		on or before

Is this gift to establish a new fund, or add to an existing fund? Add to an existing fund

Select the fund where this gift will be added to: ER Jackman General Scholarship Fund ER Jackman Unrestricted Fund ER Jackman Enhancement Endowment Fund

Is this a Gift Agreement or a Statement of Intent? Gift Agreement Statement of Intent

Is the donor making a gift through a Donor Advised Fund (DAF)? Yes No

What is the DAF Entity? Ex: Fidelity Charitable

What is the DAF Fund Name? Ex: Powell Family Fund

Select the College/Unit/Area College of Agricultural Sciences

Select the Campus Signer Staci Simonich, Reub Long Professor & Dean, College of Agricultural Sciences

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