GF-E1
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):
a. An Individual ................................................Legal name:____________________________________
b. An officer of a business................................Legal business name: __________________________
c. An officer of a booster club with a tax id#....Legal club name: ______________________________
For any of the above, if you wish this signed from to serve as a receipt from the authorized recipient for your own tax purposes, please provide the associated SSN, EIN, or TAX ID#:__________________________
d. A representative of an informal group (not eligible for tax receipt)....Name:____________________
e. Other (please describe) (not eligible for tax receipt).....____________________________________
3. Type of donation:
a. Cash, coin, check................................. Dollar amount: ____________________________________
b. Supplies, equipment, property, etc....... Estimated value: __________________________________
c. 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.)
a. Monentary 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 Wayne School District.
Signature: ________________________________________________________
b. 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:
Name: _______________________________________________________
Title: _______________________________________________________
Signature: ________________________________________ Date: _______________
Received by District’s foundation/business administrator:
Name: _______________________________________________________
Title: _______________________________________________________
Signature: ________________________________________ Date: _______________
Tax reciept number: _______________________________________________________
Distribution Original to Accounting Copy to Donor Copy for School/Department
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