Security Gift Form

Notice of Intent
Donor's Name*
Donor's Mailing Address (e.g., street address or post office box)*
Donor's City/State/ZIP*
Donor's Telephone Number*
Donor's Email
Type of Security(ies)*
Number of Shares*
Expected Date of Transfer*
Transfer Type*
- Electronic (DTC)
- Mutual fund transfer
- Stock certificate and stock power (i.e., when donor or broker holds certificates)
Gift Designation:*
(e.g., class fund, endowment, unrestricted Annual Giving, other named fund)
Transferring Broker Firm Name and Contact Person*
Broker’s Address*

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