12/20/19
Authorization for Gifts-In-Kind/Leveraged Equipment
Gifts-in-kind refers to donations of objects, services, and resources other than cash. Only Department Managers or Program
Leader/Department Chair Faculty Members may accept a gift-in-kind on behalf of RCTC after securing the appropriate
approvals on this form. This form must be on file with the RCTC Foundation Office prior to accepting the gift.
PROGRAM/DEPARTMENT:____________________________________________________________
PROGRAM/STAFF CONTACT PERSON:_________________________________________________
PHONE NUMBER:____________________________________________________________________
DONOR
NAME: __________________________________________ TITLE:___________________________
COMPANY:______________________________________ PHONE:__________________________
ADDRESS:______________________________CITY:____________STATE:______ZIP:__________
DATE OF GIFT:______________EMAIL ADDRESS:_______________________________________
SIGNATURE:_________________________________________________DATE:_________________
THE FOLLOWING ITEM(S) WILL BE DONATED TO ROCHESTER COMMUNITY AND TECHNICAL
COLLEGE FOUNDATION TO BE USED FOR INSTRUCTIONAL PURPOSES AT ROCHESTER
COMMUNITY AND TECHNICAL COLLEGE: (Please Describe)
________________________________________________________________________________________________________
________________________________________________________________________________________________________
IF THIS IS A VEHICLE DONATION, INCLUDE VIN# HERE:_________________________________
This gift was given voluntarily and is made without expectation of receiving something of value in return.
DONOR DETERMINED VALUE: $_____________________
IF THE VALUE IS $5,000 OR MORE A WRITTEN APPRAISAL FROM AN INDEPENDENT APPRAISER IS REQUIRED BY THE
IRS IN ORDER FOR THE DONOR TO SUBSTANTIATE TAX DEDUCTIONS. DONORS SHOULD CONSULT THEIR TAX
ADVISOR ABOUT THE APPRAISAL REQUIREMENTS.
COLLEGE AUTHORIZATION – REQUIRED prior to submitting to RCTC Foundation.
SIGNATURE: _____________________________________________ DATE: ___________________
DEPARTMENT MANAGER OR PROGRAM LEADER/DIVISION COORDINATOR (FACULTY)
SIGNATURE:_____________________________________________ DATE: ___________________
DEAN (IF APPLICABLE)
SIGNATURE:_____________________________________________ DATE: ___________________
VICE PRESIDENT
RCTC FOUNDATION AUTHORIZATION:
SIGNATURE:_____________________________________________ DATE_____________________
EXECUTIVE DIRECTOR
Original – Foundation Office; Copy – Donor; Copy – Business Office; Copy – Vice President
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