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? Establish new fund

Enter the name of the new 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 Tim Carroll, Sara Hart Kimball Dean, College of Business Tuba Özkan-Haller, Dean, College of Earth, Ocean, and Atmospheric Sciences Susan Gardner, Dean, College of Education Scott A. Ashford, Kearney Dean of Engineering Tom DeLuca, Cheryl Ramberg-Ford & Allyn C. Ford Dean, College of Forestry Philip Williams, Dean, College of Liberal Arts Rick Settersten, Interim Dean, College of Health Eleanor Feingold, Dean, College of Science Toni Doolen, Dean, Honors College Sherm Bloomer, Chancellor & Dean, OSU-Cascades

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