National Philanthropy Day 2015Nomination Form

Outstanding Planned Giving/Legacy Honoree

This award will honor an individual, deceased or living, whose bequest/planned gift has or will make a significant impact on an organization’s ability to fulfill its charitable mission. Nominations may be submitted by an AFP or Planned Giving Council of Palm Beach County Member. If the nominee is deceased, the gift must have been received within the last ten (10) years. If the individual is living, the gift must be irrevocable at the time this application is submitted.

Submitted By:

Name and Title of Individual Submitting Nomination:

Membership requirement; please check one:

AFP Member # (Can be retreived on the AFPwebsite

OR

Member of Planned Giving Council of Palm Beach County (membership will be confirmed by an officer of the Planned Giving Council before this nomination is considered)

Information About Organization That Benefited From Planned Gift

Name of Organization:

Mailing Address:

Mailing Address 2:

Telephone: Cell Phone:

Fax: E-mail:

Nominee Information – Outstanding Planned Giving/Legacy Honoree

Nominee Name:

Contact Person:

Contact Person Title:

Mailing Address:

Telephone: Cell Phone:

Fax: E-mail:

IMPORTANT: The Committee will not accept any nomination which utilizes resumes, newspaper articles, annual reports, etc., in substitution for concise, exact responses to the criteria outlined on the next page. However, letters of recommendation are accepted, but only at the time of the original submission of the nomination.

Please answer each of the following questions by attaching specific responses. Your response should not exceed three (3) pages. (Plus cover page)

PLEASE NOTE: BEQUEST/PLANNED GIFT MUST HAVE BEEN RECEIVED WITHIN THE LAST TEN (10) YEARS AND IF THE NOMINEE IS LIVING, IT MUST BE AN IRREVOCABLE GIFT. IF THE NOMINEE IS DECEASED, WE ASK THAT AN HEIR OR REPRESENTATIVE BE AVAILABLE TO ACCEPT THE AWARD.

1. Describe the planned gift that was made for the benefit of your charitable organization. Please include in your description the planned gift or bequest, the amount of such gift or bequest, and the date received.

2. Describe the nominee’s time, effort and financial commitment to your organization. Please include a description of the nominee’s leadership achievements in advancing the charitable purpose of your charitable organization.

3. Describe and provide specific examples of the fundraising and charitable goals achieved by the nominee’s planned gift/bequest.

4. Describe the nominee’s commitment to planned giving and his or her success in recruiting and motivating others to make bequests and planned gifts.

5. Describe nominee’s participation in other local, national or international not-for-profit organizations via planned gifts or bequests. Please list other planned gifts/bequests made by the nominee to other organizations and the date they were received.

I DO CERTIFY THAT ON the day of ,2015, the above named individual is hereby nominated for this special AFP/Planned Giving Council Award.

Date: Signature: ______

ALL NOMINATIONS MUST BE POSTMARKED AND MAILED BY FRIDAY, JULY 24, 2015.

Please send to: Dana Brookes, 6749 Columbia Ave, Lake Worth, FL 33467 or . Questions? Call 561-715-5320.

National Philanthropy Day 2015 is on Thursday, November 19th.