Statement of Financial Intent
Print Name(s) ____________________________________ E-mail Address ___________________________
Home Address ____________________________________________________________________________
City ______________________________________________ State __________ Zip ___________________
Phone Home ______________________ Business ______________________ Cell ___________________
Signature _________________________________________________________ Date ___________________
Director of Development Name(s):
I/we wish to make a gift of $____________________ to support:
Any University priority (unrestricted).
Other __________________________________________________________________________________
My/our pledge will be paid over _________ years (not to exceed five), with the first pledge payment of
$____________ to be made on or about ______________________________.
The remaining pledge payments will be made:
Annually, on or about __________________________.
Other: ________________________________________________________________________________
I/we would like to receive pledge reminders. Yes No
I/we intend to pay this pledge:
With personal funds
Through a Donor Advised Fund (DAF)
Through a Family Foundation
Other: ________________________________________________________________________________
NOTE: Corporate matching gift programs generally will not commit to satisfying personal pledges. For this
reason, matching funds cannot count as payments for personal pledge commitments. Matching gifts do qualify
for full recognition credit and for credit toward projects, as appropriate.
For gift recognition purposes, please indicate below who should receive credit for this pledge and payments:
________________________________________________________________________________________
I/we wish to remain anonymous.
Other instructions: _________________________________________________________________________
**********************************Advancement Services Use Only**********************************
Date Received:
Date Pledge Entered:
Designation:
Staff Name:
Staff Signature: