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Grant Distribution Request Form

As a fund representative of a Donor Advised fund, you may make a grant distribution request using this form. Fields that are marked with an
asterisk (*) are required. You will receive an email confirmation of your form submission.

Donor-advised fund distribution recommendations must be reviewed for up-to-date IRS charitable status by the Community Foundation before grant checks can be issued.  Our Donor Services Department will perform this due diligence and will notify the Donor if a potential grantee does not meet the required eligibility.

Distributions from donor advised funds may be awarded as grants to 501(c)(3) public charities or to quasi-governmental organizations and may not be used to pay pledges made by the Founding Donor, purchase tickets, pay participation fees, award funding for which the Founding Donor receives goods or services in return for the grant, or award grants to individuals. The minimum distribution is $250 per check.

Donor First Name : *
Donor Last Name : *
Name of Fund: *
Donor Telephone Number : *
Donor Email : *
Grantee Name/Payable to: *
Grantee Mailing Address: *
City: *
State: *
Zip: *
Grant $ Amount Requested: *
Is the grant to be restricted for a specific charitable purpose? * (checking "no" assumes grantee may use funds as needed)
If yes, describe restricted charitable purpose:
Additional comments :

Site created in loving memory of Lawrence & Betty Powell.