Charitable Fund Grant Recommendation Form

Charitable Fund Name *

GRANTEE ORGANIZATION INFORMATION

Organization Name *

Grantee Contact Person

Contact's Email Address

Organization Address

Address Line 1

Address Line 2

City

State

Zip Code

Organization Phone

RECOMMENDED GRANT AMOUNT

Grant Amount *

CHARITABLE PURPOSE

Purpose of Grant *

ACKNOWLEDGMENT OPTIONS AND SPECIAL INSTRUCTIONS

Please issue the grant (select all that apply).

In the name of a charitable fund

The fund name will be used if no other selection is made.

Anonymously

In Memory of

In Honor of

To Support the Mission and Ministry of

Special Handling Instructions

SIGNATURE OF FUND ADVISOR(S)

I certify that this grant shall not satisfy a written pledge or legal obligation of mine or any other person and that any benefit or privilege (such as gifts or tickets to events) to me or any other person resulting from this grant shall be declined.

Signature of Advisor *

Phone Number *

Date *

Signature of Advisor

Phone Number

Date