Donor Advised Fund Grant Recommendation Form - Catholic Community Foundation of Southwest Florida

Fund/Advisor Information

Name of the Fund:*

Fund #:

Name of Designated Advisor(s) #1:*

First Last

Name of Designated Advisor(s) #2 (If applicable):

First Last

Phone

Email

Grant Amount:*

Do you wish to remain anonymous:*

Yes
No

Grant Recommendation

Organization Name*

Catholic Charities Diocese of Venice, Inc.

Address

Street Address City State ZIP Code

Contact Name & Title*

Phone*

Email*

Tax ID

Website

Charitable Purpose*

General Operating Support
Specific Purpose or Project

Specific Purpose or Project*

Second Organization

Other Organization

Organization Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name & Title*

Phone*

Email*

Tax ID #*

Website

Charitable Purpose*

General Operating Support
Specific Purpose or Project

Specific Purpose or Project*

I certify that neither I nor any individual will receive any material benefit from the charitable organization as a result of this grant. I understand and acknowledge that a grant must directly and fully support a charitable program and I will not submit a recommendation intended to:*

• Fulfill a legally binding pledge or other financial obligation to the recommended charity
• Benefit myself, any specific individual, family member or business they control
• Support political campaigns or lobbying activities
• Pay for goods, services, membership benefits, event tickets, goods bought at auction or tuition

I understand that this is a recommendation and not a directive and is subject to review and approval. The Catholic Community Foundation of SW Florida will perform the necessary due diligence of the charitable organization to ensure compliance with federal regulations.

By selecting this box, I am confirming that I am authorized to make grant recommendations from the fund identified above.

Signature of Designated Advisor*

Signature Date*

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Donor Advised Fund Grant Request Form

Fund/Advisor Information

Grant Recommendation

Catholic Charities Diocese of Venice, Inc.

Second Organization

Other Organization