Restricted Gift Designation and Acknowledgment Form

Documents the donor restriction, allowable use, time horizon, and the organization's acceptance of the conditions. Used to support fund accounting and net asset classification under FASB ASC 958.

Donor Information

• Donor Type *
• Donor Name (Primary / Entity Name) *
• Second Donor Name (Joint gifts only)
• Donor Email Address *
  Used for acknowledgment letter and follow-up correspondence only.
• Donor Phone Number
• Donor Mailing Address *
  Required for IRS written acknowledgment (IRC § 170(f)(8)).
• Primary Contact Person (if different from donor)

Gift Details

• Date Gift Received *
  Use the date the organization received or legally accepted the gift (check date, wire date, or deed transfer date).
• Gift Type *
• Gift Amount (USD) *
  Enter the fair market value at date of gift. For non-cash gifts, attach qualified appraisal if value exceeds $5,000 (IRS Form 8283).
• Total Pledge Amount (if this is a pledge payment)
  Enter the full pledge commitment if this payment is part of a multi-year pledge.
• Check Number / Wire Reference / Grant Award Number
• Description of Non-Cash Asset
• Did the donor receive any goods or services in exchange for this gift? *
  Required for quid pro quo disclosure (IRC § 6115). If yes, the deductible amount must be reduced by the fair market value of goods/services provided.
• Fair Market Value of Goods/Services Provided (USD) *
  This amount will be disclosed in the acknowledgment letter and reduces the donor's charitable deduction.

Restriction Terms

• Net Asset Classification *
  Select the FASB ASC 958 net asset class that applies to this gift.
• Restriction Description (Donor's Own Language) *
  Use the donor's verbatim language where possible. Paraphrasing can create ambiguity during audits.
• Allowable Uses of These Funds *
  Select all uses the donor has explicitly authorized.
• Describe Other Allowable Use
• Explicitly Prohibited Uses (if any)
• May indirect / overhead costs be charged to this fund? *
  Affects cost allocation and fund balance reporting.
• Indirect Cost Cap (%)

Time Horizon and Release Conditions

• Restriction Effective Date *
  Date from which the restriction applies. Typically the gift date.
• Does the restriction have a defined end date or event? *
• Restriction End Date / Spend-By Date *
  Funds not expended by this date may need to be returned or renegotiated with the donor.
• Describe the Release Event or Milestone *
• Treatment of Unspent Funds at Restriction Expiration *
  Clarify disposition of any remaining balance when the restriction period ends.
• Donor Reporting Requirement
  How often must the organization report fund use back to the donor?
• First Report Due Date
  Enter the date the first stewardship or compliance report is due to the donor.

Fund Accounting Setup

• Designated Fund Name *
  This name will appear on fund statements, acknowledgment letters, and the Form 990.
• Fund Action *
• Existing Fund Code / GL Account Number
  Required if adding to an existing fund.
• Existing Endowment Fund Code / GL Account Number
• Should endowment principal be invested in the long-term investment pool?
• Applicable Spending Policy Rate (%)
  Enter the board-approved spending policy rate applicable to this endowment fund. Leave blank to apply the organization's default rate.
• Associated Program Area / Department *
  Select the program area responsible for expending and reporting on these funds.
• Assigned Fund Manager (Staff Name) *
  This person is accountable for expenditure compliance and donor reporting.

Supporting Documentation

• Is a signed gift instrument / grant agreement attached? *
• Upload Gift Instrument / Grant Agreement
  Accepted formats: PDF, DOCX, JPEG, PNG. Maximum file size: 20 MB.
• Additional Supporting Documents
  Upload any additional documents: donor correspondence, pledge cards, board resolutions, appraisals (IRS Form 8283 for non-cash gifts > $5,000), or legal opinions. Accepted formats: PDF, DOCX, JPEG, PNG. Maximum file size: 20 MB.
• Verbal Commitment Documentation Notes
• Additional Notes or Special Conditions

Organizational Acceptance and Authorization

• Has this gift been reviewed against the organization's Gift Acceptance Policy? *
  All restricted gifts should be reviewed for alignment with the Gift Acceptance Policy before acceptance.
• Describe the Policy Exception and Approval Obtained
• Confirm the organization has the capacity to fulfill the restriction as stated *
  Check to confirm that the organization's programs, timeline, and resources are sufficient to honor the donor's stated restriction. Accepting a gift the organization cannot fulfill creates legal and reputational risk.
• Submitted By (Staff Name) *
• Title / Role *
• Date of Submission *
• Authorizing Officer Name *
  The authorizing officer confirms organizational acceptance of the gift terms and conditions.
• Authorizing Officer Signature *
  Electronic signature constitutes organizational acceptance of the gift terms documented in this form.
• Authorization Date *
• Data Use Acknowledgment *
  Donor contact information collected in this form is used solely for gift acknowledgment, fund stewardship, and IRS reporting purposes. It is retained in accordance with the organization's data retention policy and is not shared with third parties except as required by law.