St. Cloud State Foundation, Inc. Deposit Form

The purpose of the St Cloud State University Foundation is to support and enhance SCSU’s ability to ignite students’ learning and discovery of their gifts, their passions, and their potential contributions to society.

Complete this form and send all contributions promptly so an acknowledgment may be sent to the donor in a timely manner. Completed forms, checks and supporting documentation should be sent to the Lewis House. Contact Laura Gapinski (308-0915) if you have questions.

Deposit Submitted By:

Phone Number:	Date:

Enclosed:	Deposit Information:

Total Cash	$	Fund Number

Total Checks	$	Fund Name

Total Credit Cards	$	If you do not know the fund name and number contact the

SCSU Foundation.

TOTAL DEPOSIT	$

Additional Information:

In compliance with U.S. Treasury Regulation 1.170A-13(f), the receipt issued to the donor must not include the value of any goods or services (other than token items for donor recognition purposes) made available to the donor as a result of this contribution and if goods or services have been made available a description and good faith estimate of the value must be provided.

Gift (No goods or services will be made available as a result of this contribution.)

Goods or services will be made available as a result of this contribution.

Itemized Description of Goods or Services (not simply “advertising”)	Estimated Value

[Did each individual contribution receive the same benefits? If no, please submit on separate deposit forms.]