PCA Foundation Grant Distribution Recommendation Form Required information is marked by an asterik; please ensure these items are completed before submitting this form. If you are submitting the name of a new grant recipient, please provide the ministry's official mailing address and telephone number. Donor and Fund Information Name of Fund(required) * Recommended By:(required) * Fund #:(required) * Email Address (a submission confirmation email will be sent)(required) * Home Phone Cell Phone Street Address / PO Box City & State Zip Code Name of Christian Ministry(required) * Attention of: (if applicable) Telephone Website Ministry's Official Mailing Address (Street or PO Box) City & State Zip Code Amount(required) * Anonymous ?(required) * Yes No Make it Recurring?(required) *Choose "Yes" if you would like us to schedule this recommendation as a recurring distribution from your fund based on the frequency selected below. Choose "No" if this is a one-time recommendation. Yes No Distribute Until Further Notice?(required) *This selection is only required when you ask for this recommendation to be processed as an automatically "Recurring" distribution from your fund. If it is not to be processed "Unitl Further Notice", please provide a beginning date and an ending date in the "Custom Instructions" field below. Yes No Distribution Frequency(required) *If this is to be a "Recurring" distribution, please indicate how often you would like this recommendation to be distributed from your fund. Please select a distribution frequency here. Monthly Quarterly Semi-Annually Annually Custom (provide details in the next block) Custom Distribution Instructions (please include both the Month & Year for the Start Date and End Date) FOR SUPPORT OF: (if applicable). Do you have additional recommendations? (Maximum of 4 Per Submission) Select # of Additional Recommendations (if any) None 1 2 3 #2 - Grant Distribution Recommendation Name of Christian Ministry(required) * Attention of: (if applicable) Telephone Website Ministry's Official Mailing Address (Street or PO Box) City & State Zip Code Amount(required) * Anonymous ?(required) * Yes No Make it Recurring?(required) * Yes No Distribute Until Further Notice?(required) * Yes No Distribution Frequency(required) * Please select a distribution frequency here. Monthly Quarterly Semi-Annually Annually Custom (provide details in the next block) Custom Distribution Instructions (please include both the Month & Year for the Start Date and End Date) FOR SUPPORT OF: (if applicable). #3 - Grant Distribution Recommendation Name of Christian Ministry(required) * Attention of: (if applicable) Telephone Website Ministry's Official Mailing Address (Street or PO Box) City & State Zip Code Amount(required) * Anonymous ?(required) * Yes No Make it Recurring?(required) * Yes No Distribute Until Further Notice?(required) * Yes No Distribution Frequency(required) * Please select a distribution frequency here. Monthly Quarterly Semi-Annually Annually Custom (provide details in the next block) Custom Distribution Instructions (please include both the Month & Year for the Start Date and End Date) FOR SUPPORT OF: (if applicable). #4 - Grant Distribution Recommendation Name of Christian Ministry(required) * Attention of: (if applicable) Telephone Website Ministry's Official Mailing Address (Street or PO Box) City & State Zip Code Amount(required) * Anonymous ?(required) * Yes No Make it Recurring?(required) * Yes No Distribute Until Further Notice?(required) * Yes No Distribution Frequency(required) * Please select a distribution frequency here. Monthly Quarterly Semi-Annually Annually Custom (provide details in the next block) Custom Distribution Instructions (please include both the Month & Year for the Start Date and End Date) FOR SUPPORT OF: (if applicable). Donor Acknowledgement: I acknowledge 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.(required) * Yes, I agree with the PCAF's Donor Acknowledgement statement. Signature: Donor or Donor's Authorized Advisor(required) * By typing your name above, and entering the date to your right, you are signing and dating this form. Date(required) * SPECIAL NOTE: Distributions from the PCA Foundation’s Advise & Consult Funds and Increase Funds, both considered to be donor-advised funds (DAFs), are only permitted to benefit the organizations receiving the distributions, not the donors to the PCA Foundation’s DAFs, donor advisors, or members of any donor’s or donor advisor’s family. This means that PCA Foundation’s DAFs 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 fundraising 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. This field should be left blank Submit Recommendation Please wait...
