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Full Name

Address

Address 1

City

ZIP / Postal Code

State / Province

Country

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Phone Number

Email Address

Name of Fund

Estimated Amount of Initial Gift

Timing of Gift

Now

Future

Type of Fund

Missions

Facility

Compassion

General

Distribution Directions

Distribute only accounting income.

Distribute a percentage of corpus annually (see below to give specifics).

Distribute income and/or corpus at the discretion of the Board.

Distributions restricted as outlined above.

Distribution Directions for Percentage Distribution (If you chose to distribute a percentage of corpus annually on the previous question, please list the percentage you would like distributed annually below)

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