Naming Opportunities Contribution and Agreement Form

Naming Opportunities Contribution and Agreement Form
My affiliation with HACC, Central Pennsylvania’s Community College (please select all that apply):
 Alumnus  Board Member
 Community Partner
 Donor
 Employee
 Parent
Please complete this section or attach a business card.
Prefix(es):  Mr.
 Ms.
 Mrs.
 Dr.
 Prof.
 Other: ______________
Name(s): ________________________________________________________________________________
Organization (if applicable): ________________________________________________________________
Preferred Address:  Home  Business
Street: ____________________________________ City: _______________ State: ______ Zip: ________
Preferred Phone:  Home  Business  Cellular __________________________________
Preferred Email:  Personal  Business __________________________________________
Campus:  Gettysburg  Harrisburg  Lancaster  Lebanon  York
Using the list of naming opportunities provided (www.hacc.edu/namingopportunities), please indicate which
option is of most interest to you:
 Building ______________________________________________________________________________
 Room_________________________________________________________________________________
 Program_______________________________________________________________________________
 Endowed Chair_________________________________________________________________________
 Other_________________________________________________________________________________
Name of donor(s) as it should appear: _________________________________________________________
If this gift is made in memory and/or in honor of someone, please provide the names below:
 My gift is in memory of: __________________________________________________________________
 My gift is in honor of: ____________________________________________________________________
 Please notify ______________________________ of my/our gift at the following mailing address
________________________________________________________________________________________
Relevant background information or history on the donor or honoree:
_____________________________________________________________________________
_____________________________________________________________________________
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Payment Options:
 Enclosed is a gift of $____________
 I pledge $_______________________________over a ___________ - year period (maximum of four years).
My first pledge payment of $__________ is enclosed. Please mail a pledge reminder to me:
О Annually о Monthly о Quarterly о other ________
I would like the amount of each payment to be: _______________________
 I would like to contribute via credit card (Please visit www.hacc.edu/givenow)
 I would like to contribute stock: ___________________________________
Note: Please contact the HACC Foundation at [email protected] for the appropriate stock forms.
Public Recognition:
May the College publicly acknowledge this commitment?
 Yes  No
If “yes,” the College will work closely with you to determine how you would like your generosity to be
recognized. Examples of public recognition include news releases, special events, plaques and signage.
Name of donor(s) as it should be acknowledged: ________________________________________________
I have read and agree to abide by all HACC Foundation naming-related policies and procedures
(www.hacc.edu/namingopportunities/policy).
Print Name of Donor(s): ____________________________________________________________________
Signature of Donor(s): _____________________________________________________________________
Date: ___________________________________________________________________________________
I accept this agreement on behalf of the HACC Foundation.
Printed Name of HACC Foundation Official: ___________________________________________________
Signature of HACC Foundation Official: _______________________________________________________
Date: ___________________________________________________________________________________
Please make checks payable to the HACC Foundation and return the completed form, along with your
contribution, to the HACC Foundation, One HACC Drive, Harrisburg, PA 17110. Thank you!
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