Is this gift for a current use or endowed fund? Current Use Fund Endowed 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

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	Pop It
(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 Add to an existing fund

Enter the name of the new 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

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

Select the College/Unit/Area College of Agricultural Sciences College of Business College of Earth, Ocean, and Atmospheric Sciences College of Education College of Engineering College of Forestry College of Liberal Arts College of Pharmacy College of Health College of Science Carlson College of Veterinary Medicine Honors College OSU-Cascades Scholarship Office Student Affairs Marine Mammal Institute Linus Pauling Institute 4-H Extension Athletics

Campus Signer Staci Simonich, Reub Long Professor & Dean Tim Carroll, Sara Hart Kimball Dean Tuba Özkan-Haller, Dean Susan Gardner, Dean Scott A. Ashford, Kearney Dean of Engineering Tom DeLuca, Cheryl Ramberg-Ford & Allyn C. Ford Dean Lawrence R. Rodgers, Dean David Bearden, Dean Rick Settersten, Interim Dean Eleanor Feingold, Dean Susan J. Tornquist, Lois Bates Acheson Dean Toni Doolen, Dean Sherm Bloomer, Chancellor & Dean Jon Boeckenstedt, Vice Provost for Enrollment Management Dan Larson, Vice Provost for Student Affairs Lisa Ballance, Director Emily Ho, Director Cathryn Haas, Program Leader Kristopher Elliott, Interim Vice Provost and Interim Director S. Scott Barnes, Vice President & Director of Athletics

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