Scott Community College Foundation
Gift-in-Kind Donation Transmittal Form
Instructions: This form must be completed in its entirety with the donor’s signature as well as
that of the college agent receiving the donation. The form then must be immediately submitted
with all certificates of ownership:
Please select one:
Lysa Hegland, Executive Director
Scott Community College Foundation
I wish to receive a receipt for this gift for my own or my company’s taxes
I do not intend to claim this donation on my own or my company’s taxes
Donor Name:
City, State, Zip:
Donor Contact: Phone:
Item(s) donated and brief description (manufacturer, model, serial number, etc.):
Donor estimate of donation value: $
I hereby donate to the Scott Community College Foundation all items listed and valued above
without restriction except as follows:
Donor (or Agent) Signature Date College Agent Receiving Donation Date
Donation Acknowledgment Date
Executive Director, SCC Foundation