GRANT DISTRIBUTION RECOMMENDATION FORM

Yellow boxes indicate required information; please ensure these items are completed before submitting this form.
If a new proposed recipient please provide address and telephone number.
 

     Name of Fund:             Fund Account Number 

     Recommended by:              Telephone  Number:    

     Email Address:         
                                                          Name of Donor or Donor Advisor

     Your Current Mailing Address:   

                         City, State Zip Code:     
 

     1. Christian Ministry:          To the attention of (if applicable):

     Address:     City, State Zip

     Telephone:          Total Amount:                    Anonymous?   Yes No 

     Designated for the support of (if applicable):

     2. Christian Ministry: To the attention of (if applicable):

     Address:     City, State Zip

     Telephone:          Total Amount:           Anonymous?   Yes No 

     Designated for the support of (if applicable):

     3. Christian Ministry: To the attention of (if applicable):

     Address:     City, State Zip

     Telephone:          Total Amount:           Anonymous?   Yes No 

     Designated for the support of (if applicable):

     4. Christian Ministry: To the attention of (if applicable):

     Address:     City, State Zip

     Telephone:          Total Amount:           Anonymous?   Yes No 

     Designated for the support of (if applicable):

If you are making more than four recommendations please submit this form and repeat process.

 The grant(s) recommended in this notice is/are intended to benefit the recipient organization(s), not a donor, a donor advisor, or any related person, in accordance with the existing policies of the PCA Foundation.
 

   X  Donor or Donor Advisor Signature               Date:         
                                                                               By typing your name and date above, you are signing and dating this form

Distributions from the PCA Foundation’s donor advised funds (DAFs), which include its Advise & Consult Funds and Recommended Endowments,  are only permitted to benefit the organizations receiving the distributions, not the donors to the PCA Foundation’s DAF, donor advisors, or members of any donor’s or donor advisor’s family.  This means that PCA Foundation’s DAF funds cannot be used (a) to satisfy any existing and legally binding pledge of a contribution made by a donor, a donor advisor, or a family member of either; (b) to support a fund-raising campaign or event in which a donor, a donor advisor, or a related person will be expected to receive admission tickets or any other gift of a more than negligible value; (c) to pay tuition, fees or other expenses associated with an educational, vacation, recreational or similar pursuit of a donor, a donor advisor, or a related person; or (d) to compensate, pay, or reimburse the expenses or benefit in a similar manner a donor, a donor advisor, or a related person in any circumstance in which the individual is not providing meaningful and extensive services to assist the charitable organization in carrying out its mission.

PCA Foundation, Inc. • 1700 North Brown Road, Suite 103 • Lawrenceville, GA 30043
Phone: 678-825-1040 • Toll Free: 800-700-3221 •  Fax: 678-825-1041 • Email: pcaf@pcanet.org