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University of Wisconsin-Stout
ACCEPTANCE OF GIFTS-IN-KIND
THIS FORM MUST BE COMPLETED AND APPROVED PRIOR TO ACCEPTANCE AND SHIPPING OF ANY GIFT-IN-KIND
Complete the entire form through signatures for Dean/Director. See page 3 of this form for added information on
procedures and instructions.
Description of the gift-in-kind: Click here to enter text.
Benefits; program and/or course implications (this information is necessary for the letter of acknowledgment):
Click here to enter text.
Donor: (include the name of the donor and contact person for acknowledgement purposes for anonymous gift, indicate “anonymous”
Company
Contact
Person:
Click here to enter text.
Email: Click here to enter text.
Phone: Click here to enter text.
Date of offer: Click here to enter text.
Target shipping date: Click here to enter text.
Street Address Click here to enter text.
City Click here to enter text.
State Click here to enter text.
ZIPClick here to
enter text.
Estimated Market Value Provided by the Donor:
Age of gift in years: Click here to enter text.
Click here to enter text.
Note: The University acknowledges the gift. It neither accepts nor rejects the estimated value. The estimated
value is used for internal insurance and inventory purposes only. The donor must be able to document the value
for IRS purposes independent of the University.
Gift Negotiation (UW-Stout): If the gift value is $5,000 or more, this form must route to Brent Tilton, Procurement
and Materials Management Director, prior to submitting to Research Services.
Procurement Director: _____________________________________________________________________
(If applicable)
Signature and Date
☐Yes ☐No Were any restrictions as to use, disposition, or reporting requirements stipulated as a condition of
the gift? If “Yes,” explain: Click here to enter text.
☐Yes ☐No Is there a purchase discount? If “Yes,” call the Director of Procurement, 232-2346.
☐Yes ☐No Is a report(s) required? If “Yes,” provide detail: Click here to enter text.
☐Yes ☐No Are there any special conditions concerning the gift? If “Yes,” provide detail: Click here to enter text.
Potential costs associated with the gift are below: (All costs are the responsibility of the accepting
unit/department) Also include costs if the gift involves remodeling, alteration and/or renovations, regardless of
funding sources (refer to UW-Stout Policy 84-39 Physical Plant Alternations). Note: the UW System policy for
accepting hazardous wastes/chemicals is on page 3 of this form.
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☐Yes ☐No Remodeling Costs (training, operating) $ Click here to enter text.
☐Yes ☐No Physical Plant Costs (hook-up, service) $ Click here to enter text.
☐Yes ☐No Space Requirements/Storage Costs—Attach Plan & Costs $ Click here to enter text.
☐Yes ☐No Maintenance/Operating Costs—Attach 6-Month Utilization Plan & Costs $ Click here to enter text.
☐Yes ☐No Hazardous Waste Costs $ Click here to enter text.
☐Yes ☐No Disposal Costs $ Click here to enter text.
☐Yes ☐No Material Safety Data Sheets –Attach sheets and provide any further information $ Click here to enter text.
☐Yes ☐No Personnel Costs (training, operating) $ Click here to enter text.
☐Yes ☐No Shipping Costs $ Click here to enter text.
☐Yes ☐No Other Cost $ Click here to enter text.
☐Yes ☐No Provide any further information for any items: Click here to enter text.
If “yes” is selected for any of the above, this form must route to Shirley Klebesadel, Physical Plant Director, prior to
submitting to Research Services.
Physical Plant Director: ____________________________________________________________________
(If applicable)
Signature and Date
If this is computer software or IT related, please complete this section: IMPORTANT: if your response to any of
these questions is “yes”, route the form to Doug Wahl, Chief Information Officer, prior to submitting to Research Services.
☐Yes ☐No Is the gift software?
☐Yes ☐No Is the gift hardware?
☐Yes ☐No Does this gift require additional peripheral equipment or any other equipment to function: If ‘yes’,
provide detail: Click here to enter text.
☐Yes ☐No Does equipment need to be purchased: If “yes”, identify equipment and cost: Click here to enter text.
Chief Information Officer: ____________________________________________________________________
(If applicable)
Signature and Date
Negotiator’s
Name:
Unit/Department: Click here to enter text.
College/Division: ☐CAHSS ☐CEHHS ☐COM ☐STEM ☐CHANCELLOR ☐ASA ☐ASLS
Approval for Acceptance: If approximate value of the gift is $500 or greater, or if any significant costs of accepting the gift are
anticipated, the Provost’s signature is required.
Department/Unit Chair:
Signature and Date
Dean/Director:
Signature and Date
Provost:
Image Stamp and Date
Research Administrator :
Image Stamp and Date
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Procedures for Accepting Gifts-in-Kind
and
Instructions for Use of this Form
After completion of this form, forward it to Research Services, 152 Vocational Rehabilitation Building. If
you have questions, please call Research Services at x1126.
Gifts-in-kind are defined as equipment, supplies, or property offered without significant
restrictions as to use or requirements for reporting, use, or disposition. Purchase discounts are
not gifts-in-kind. If this is a purchase discount, please contact the Director of Purchasing. The
acceptance of gifts-in-kind is governed by UW System and UW-Stout Policy 93-56.
This form must be completed and approved prior to acceptance of all gifts-in-kind. This form may be
initiated by any member of UW-Stout faculty or staff involved in negotiations for such a gift. University of
Wisconsin System policy requires that the Chancellor or designee approve all gifts accepted by the
University. At UW-Stout, the responsibility for accepting gifts-in-kind with a value of less than $500, and
with no anticipated annual costs of maintenance or operations, has been delegated to the Research
Administrator. For all gifts with a value of $500 or greater, or with annual maintenance or operations
costs, the Provost must approve acceptance of the gift. The Research Administrator will report all gifts-inkind to the Board of Regents for acceptance by the University of Wisconsin System.
If significant anticipated costs are associated with accepting the gift, they must be fully addressed before
final acceptance. "Significant" means cost beyond those which can easily and will be absorbed by the
receiving unit. Significant costs could include: shipping, storage, remodeling, hookup, staff training,
disposal, or operating and maintenance costs. Of special concern are the costs associated with computer
equipment maintenance and the acceptance/storage/disposal of hazardous wastes. The acceptance of
chemicals or wastes from third parties is covered in the University of Wisconsin System Physical Planning
and Development Policy and Procedures Manual, Part 7; Section 7D, Hazardous Substances
Management:
No University institution or employee is to accept donated hazardous substances or
chemicals from outside sources unless a specific (written) plan exists for the use of the
entire quantity of the substance or chemical within six (6) months of its receipt.
The law stipulates that no University institution, which is not an approved storage facility,
may accept hazardous waste from any person or organization that is not directly related to a
program, function, or facility of that institution.
Always request any applicable Material Safety Data Sheets prior to accepting the gift. If in doubt, always
check with the Hazardous Material Management Coordinator.
Distribution of this form is made by Research Services. Copies are forwarded to the Negotiator,
Department Chairperson, the Dean, the Vice Chancellor for Administrative and Student Life Services, the
Inventory Coordinator, and the Risk Management area.
NOTE:
Please initiate and process this form promptly.
It is important to respond promptly to donors.
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