GF Policy Exhibit #1 – “Donation, Contribution, or Sponsorship Form”

Policy Exhibit #1 GF

“Donation, Contribution, or Sponsorship Form”

Donation, Contribution, or Sponsorship Form

This form must be completed, signed, and turned in for all such occurrences greater than $250.

To be filled out by donor, contributor, or sponsor:

1. Date of donation: ___________________________________ (Must be prior to donation or initiation of construction.)

2. I am making this donation as (select one and fill in the legal name):

G An Individual ………………………………………………..Legal name: _________________________________________

G An officer of a business ………………………………… Legal business name: __________________________________

G An officer of a booster club with a tax id # ……… Legal club name: _____________________________________

For any of the above, if you wish this signed form to serve as a receipt from the authorized recipient for your own

tax purposes, please provide the associated SSN, EIN, or TAX ID#: ____________________________________

G A representative of an informal group (not eligible for tax receipt)…….. Name: ____________________________

G Other (please describe) (not eligible for tax receipt)……___________________________________________

3. Type of donation:

G Cash, coin, check …………………………… Dollar amount: _______________________________________________

G Supplies, equipment, property, etc……. Estimated value: ______________________________________________

G Volunteer time ………………………………. Estimated worth: _____________________________________________

4. Detailed description of what is being donated: _______________________________________________________________

______________________________________________________________________________________________________

5. Program, school, department, class, or activity, if any, to which you restrict use of your donation. Restricted funds will be

used only for the named restriction: (Donations may not be restricted to use for an individual employee.)

______________________________________________________________________________________________________

6. Representation: (Mark and sign appropriate one.)

G Monetary or property donor:

I hereby certify that I hold legal title to the funds/property being donated, that I am authorized to make such

donation, and hereby transfer full title of the funds/property being donated to the __________School District.

Signature: _______________________________________________________

G Volunteer:

I hereby certify that I willingly donate my time and that I will not be compensated for my donated time by any

source and that if I am given significant unsupervised access to a student in connection with my volunteer

assignment, I must also obtain a volunteer form from the principal and complete it and submit it to Human

Resources and be finger-printed.

Signature: _________________________________________

To be filled out by district/school recipient:

Authorizer per District’s donation policy: Received by District’s foundation/business administrator:

_____________________________________________      ________________________________________________

Name:                                                                Name:

_____________________________________________      ________________________________________________

Title:                                                                   Title:

_____________________________________________      ________________________________________________

Signature:                                      Date:           Signature:                                              Date:

_____________________________________________ ________________________________________________

Tax receipt number:

________________________________________________

Distribution Original to Accounting Copy to Donor Copy for School/Department