Grant Recommendation Form

"*" indicates required fields

Advisor's Name*

First Last

Advisor's Email*

Name of Fund*

Date*

I recommend the following grant(s) to the Board of Directors. I understand that this is a recommendation and not a direction, and that the Wabash Valley Community Foundation may deny this grant request if it does not meet the policies of the Foundation and the requirements of the Pension Protection Act of 2006.

Total Grant Amount Requested*

Grant Recommendation(s)

Organization Name

Executive Director/Contact Name

Address

Street Address City State ZIP Code

Grant Amount

Purpose

If blank, grant will be unrestricted

Anonymous?

Yes

Organization Name

Executive Director/Contact Name

Address

Street Address City State ZIP Code

Grant Amount

Purpose

If blank, grant will be unrestricted

Anonymous?

Yes

Organization Name

Executive Director/Contact Name

Address

Street Address City State ZIP Code

Grant Amount

Purpose

If blank, grant will be unrestricted

Anonymous?

Yes

Donor Advisor:

Requirements Certification*

I certify that the grant(s) recommended meets the requirements, specifically that the grant will NOT:

Pay for dues, membership fees, tuition, goods from charitable auctions, or other goods or services (including dinners, tickets, etc.) that provide more than an incidental benefit to me or any other individual;
Support a political campaign or lobbying activity;
Support a private, non-operating foundation.

Acknowledgement*

I acknowledge:

The grant recommendation(s) must be for charitable purposes and must receive approval by the Wabash Valley Community Foundation Board of Directors.

Phone

This field is for validation purposes and should be left unchanged.