Designated Fund Agreement Worksheet

Designated Funds are established to provide grants to specified nonprofit organizations. Often created by bequest, these funds ensure a steady stream of annual income to the fundholders’ favorite nonprofit organizations for as long as the nonprofit continues in the effective pursuit of its mission.

This Worksheet is used to create the agreement establishing a Designated fund at NCCF. Please fill out the information below.

General Information

NCCF does not share, sell, trade or exchange personal data or any information about its donors and fundholders unless expressly permitted to do so or if required by law.

Name of Fund * 🛈

Establishing Donor #1

Prefix *

If "Other," please explain *

First Name *

M.I.

Last Name *

Suffix

Primary (Home) Mailing Address *

Primary (Home) Mailing Address Line 2

City *

State *

Zip Code *

Email Address *

Home Phone *

Mobile Phone

I /this donor has a work or seasonal/weekend home address

Mailing Address *

Mailing Address Line 2

City *

State *

Zip Code *

Work Email Address

Work Phone

Mobile Phone *

When are you typically at your seasonal address? *

add a second Establishing Donor

Establishing Donor #2

Prefix *

If "Other," please explain *

First Name *

M.I.

Last Name *

Suffix

Primary (Home) Mailing Address *

Primary (Home) Mailing Address Line 2

City *

State *

Zip Code *

Email Address *

Home Phone

Mobile Phone *

This Donor has a work or seasonal/weekend home address

Mailing Address *

Mailing Address Line 2

City *

State *

Zip Code *

Seasonal Email Address

Seasonal Phone

When are you typically at your seasonal address? *

Add a third Establishing Donor

Establishing Donor #3

Prefix *

If "Other," please explain *

First Name *

M.I.

Last Name *

Suffix

Primary (Home) Mailing Address *

Primary (Home) Mailing Address Line 2

City *

State *

Zip Code *

Email Address *

Home Phone *

Mobile Phone *

This Donor has a work or seasonal/weekend home address

Mailing Address *

Mailing Address Line 2

City *

State *

Zip Code *

Seasonal Email Address

Seasonal Phone

When are you typically at your seasonal address? *

Fund Type: Endowed or Non-Endowed

Endowments/Endowment funds are permanent funds established to carry out your philanthropic intentions in perpetuity. Assets are invested for growth, and the amount available for grants each year is based on a Community Distribution Policy with an objective of distributing up to 5% of the Fund's market value annually. This policy sets the annual grant limits. This fund is intended to make grants in perpetuity.

Non-Endowed funds permit grant distributions in any amount (minimum of $250 per grant) at any time. there are no grant distribution limits. If the fund balance is exhausted, the fund terminates. A non-endowed fund may be converted to an endowment (usually upon the death of the original donor/s), but an endowed fund may not become a non-endowed fund.

Pass-Through funds–because they are temporary and short in duration–are held in a Money Market account. These funds are for the short term, with the entire fund likely to be distributed within 12 months.

Select Fund Type: *

Endowed

Non-Endowed

Pass-Through

I/we wish the fund to become an endowment upon the death of the last establishing donor.

Recognition and Acknowledgements

Grant Acknowledgements Options:

1. I will let you know my recognition preferences on a case-by-case basis. (Note: You will have an opportunity to indicate your preferences each time you recommend a grant.)

2. I want my name and the name of the fund known to grant recipients and published in any public listings of grants, including those published by NCCF and grantee organizations.

3. I do not want grant recipients to know grants are from me, but the name of the fund may be published in any public listings of grants (This option is appropriate when the name of the fund does not include a family name-e.g., The Local Area Fund.)

4. I want to make all grants anonymously. I want to remain anonymous both to grant recipients and in any public listings of grants.

Please Select a Grant Acknowledgement Option: *

Option 1 (case-by-case basis)

Option 2 (my name and fund name)

Option 3 (fund name only)

Option 4 (completely anonymous)

Gift Acknowledgement Options: *

I would like my name to be included in the list of contributors to NCCF funds. (Actual gift amounts are not listed.)

I prefer not to be recognized by NCCF for contributions to my fund(s) or for my support of other NCCF funds.

Mail:
The groups you support typically like to send a thank-you letter to you, as well as put you on their mailing list for newsletters, annual reports and organizational updates, etc. We ask them to send all correspondence directly to you unless otherwise specified.

Note: We do not sell, distribute or share donor contact information to third parties or other nonprofits.

Please select one of the mail options below: *

Please share my contact information with grantees.

Please DO NOT share my contact information, or forward any correspondence from grantee organizations.

Please DO NOT share my contact information but forward thank you letters only to:

Please DO NOT share my contact information, but forward all fund mail from grantee organizations to:

*

Establishing Donor #1

Establishing Donor #2

Other (please contact NCCF)

Fund Statements

Fund Statements are posted to our fund-advisor portal quarterly and all donors receive email notification when statements are issued.

I would like an additional individual to receive quarterly statement notification

Please indicate the name, address and email of any individual other than the establishing donors who you want to receive quarterly statement notification.

Note: Any additional fund statement contact not connected to the fund must supply the following:

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Designated Nonprofit(s)

I would like my gifts to be used by the specific organization(s) indicated below.

Organization Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Is this organization a 501(c)(3) public charity? *

Yes

No

add another organization

Organization 2 Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Is this organization a 501(c)(3) public charity? *

Yes

No

add another organization

Organization 3 Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Is this organization a 501(c)(3) public charity? *

Yes

No

Gift Information

Fund Creation

What type of gift(s) do you plan to make? Check all that apply. *

Current

Planned

Current

Type of Gift: *

Cash/Check

Securities/ Stock

IRA/Retirement plan assets

Other

For "Other," please explain: *

Planned

Type of Gift: *

For "Other," please explain: *

Gift Amount (approx.): *

Please make checks payable to The Northwest CT Community Foundation, Inc. with the fund name in the memo line. For the transfer of funds by wire, or for gifts of securities or complex assets, please visit Information for Current Donors.

Contributions are Irrevocable: All gift contributions made to The Northwest CT Community Foundation, Inc. become assets of the Northwest CT Community Foundation, Inc. and are irrevocable as tax deductible gifts. All gifts to the Northwest CT Community Foundation Inc. must further the charitable purpose and mission of the Northwest CT Community Foundation, Inc. The Northwest CT Community Foundation, Inc. reserves the right to review and approve all contributions.

Signatures

Name *

Signature *

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Name

Signature

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