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KOCH
FOUNDATION
MATCHING GIFT
PROGRAM
PROCEDURE FOR MATCHING GIFTS IN THE
K
OCH FOUNDATION MATCHING GIFT PROGRAM
The eligible donor completes Section A of the Matching Gift Program
form and sends the gift to the designated recipient institution.
The institution reviews Section A, completes Section B and sends to
Koch Foundation, Inc. will then review the completed form and, if all
requirements have been met, will match the gift during the quarter in
which it was received.
Additional forms may be obtained from Human Resources. If you have any questions, you may call Koch Foundation,
Inc. at 812-465-9800. The Matching Gift Coordinator will help you.
MATCHING GIFT PROGRAM SECTION A
To be completed by DONOR
Please print or type
You can match up to $ of my personal gift of $ to:
(Name of Hospital, Educational Institution, Museum or Zoo)
which is authorized to report this gift to Koch Foundation, Inc. to apply for a matching gift under its Matching Gift Program.
(Donor’s Name – Last, First, Middle Initial)
(Home Address – Street, City, State, Zip Code)
Employee
(Company) (Company Location)
(Date of Employment)
(Signature) (Date)
MATCHING GIFT PROGRAM SECTION B
To be completed by an appropriate OFFICER of the institution
Please print or type
I certify the receipt of the gift of $ to:
(Name of Donor)
as described in Section A, to the eligibility of this institution as described in the program and that the gift will be used to
support the primary objectives of the institution.
(Print or Type Full Name of Certifying Officer) (Title)
(Name of Institution)
(Full Address of Institution)
(Authorized Signature) (Date)
Return form to: Koch Foundation, Inc. Matching Gift Program, 10 S. 11
th
Ave., Evansville, IN 47712
Koch Foundation, Inc.
Matching Gift Program
10 South 11
th
Avenue
Evansville, IN 47712
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Completed 2 December 2021

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