Grant Recommendation Form

Fund Name*

As the Advisor to the Community Foundation of Southern Indiana, Inc. for the above-listed Fund, I recommend making from the above-named fund the grant or grants listed below.

I certify that the donors, advisors, or other parties related to me or to this fund will not receive any substantial benefit in connection with this recommended grant. I understand and acknowledge that I cannot claim a charitable deduction for a grant made from this donor advised fund, even if the grantee sends me a tax receipt. I understand and acknowledge that a grant must directly and fully support a charitable program, and therefore, I acknowledge that this grant:

- Must receive approval by the Community Foundation of Southern Indiana, Inc. Board of Directors.

- Does not fulfill any legally enforceable financial obligations of me, advisors to the fund, or other parties related to me or to this fund.

- Does not permit me, my family or any related parties to me or to this fund to acquire a benefit, receive any goods or services or non-tax deductible benefits for myself or any specific individual in exchange for this payment.

- Will not support political campaigns or lobbying activities.

- Will not pay for dues, tangible membership benefits, goods from charitable auctions, or other goods or services.

- Will not pay for attendance at galas, sporting events, or benefit events.

- Will not be used for any specific individual (including grants to an entity for the benefit of a specific individual) or for loans to donors, advisors or other parties related to me or to this fund.

- Will not receive any tangible benefits for making grant from fund.

* Minimum grant recommendation amount is $250

Your Information*

First Last

I hereby certify that I have read and reviewed the previous acknowledgments, and I hereby certify that I am not accepting any tangible goods or benefits in exchange for this recommended grant.*

I agree

Phone*

Email*

Do you wish your grant to be made anonymously?*

If you choose to make your grant anonymously, the organization receiving the grant will not be informed of your name, fund name, or contact information.

What information can we share with the grantee organization and how should they communicate with you? Select all that apply.*

The grantee organization may wish to communicate with you as the advisor to the Fund. Direction from you will help the Foundation respond to these requests. Please check the appropriate box.

My name may be released.
My fund name may be released.
My mailing address may be released.
I prefer the grantee direct correspondence through the Community Foundation; do not release my mailing address to the grantee organization.

Amount Recommended*

Minimum grant recommendation amount is $250.00

Full Name of Grantee Organization/Contact Person*

Address of the Grantee Organization*

Street Address Address Line 2 City State ZIP Code

Purpose (if other than for general support)

Attach Additional Document

Max. file size: 32 MB.

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