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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
Directions: Complete the entire form through signatures for Dean/Director. See bottom of 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
Click here to enter text.
Name:
Street Address: Click here to enter text.
City: Click here to enter text.
Contact
Person:
State: Click here to enter
ZIP: Click here
text.
to enter text.
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.
Gift Negotiation (UW-Stout):
☐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 Purchasing, 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.
☐Yes ☐No Does this involve tax forms from the donor? If “Yes,” send to Research Services, 152 VOCR.
Estimated Market Value Provided by the Donor: Click here to enter
Age of gift in years: Click here to enter text.
text.
Negotiator’s
Name:
Signature:
Click here to enter text.
Date: Click here to
enter text.
Department: Click here to enter text.
College/Division: ☐CAHSS ☐CEHHS ☐COM ☐STEM ☐CHANCELLOR ☐ASA ☐ASLS ☐DISC
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Potential costs and other considerations associated with the gift:
All costs are the responsibility of the accepting department. Note: the UW System policy for accepting hazardous
wastes/chemicals is on page 3 of this form. Please check and complete all that apply.
☐Personnel Costs (training, operating) $ Click here to enter text.
☐Remodeling Costs $ Click here to enter text.
☐Shipping Costs $ Click here to enter text.
☐Physical Plant Costs (hook-up, service) $ Click here to enter text.
☐Space Requirements/Storage Costs—Attach Plan & Costs $ Click here to enter text.
☐Maintenance/Operating Costs—Attach 6-Month Utilization Plan & Costs $ Click here to enter text.
☐Hazardous Waste Costs $ Click here to enter text.
☐Disposal Costs $ Click here to enter text.
☐Other Costs $ Click here to enter text.
☐Material Safety Data Sheets Attach Sheets & Provide any further information Click here to enter text.
☐Provide any further information for any items: Click here to enter text.
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.
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.
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.
Signature:
Date:
Signature:
Date:
Signature:
Date:
Signature:
Date:
Signature:
Date:
Department/Unit Chair:
Dean/Director:
Chief Information Officer:
Research Administrator:
Provost:
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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.
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 UWStout, 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-in-kind 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.
Upon receipt of this gift, the negotiator is responsible for completion of the “A” or “B” sheet and filing it with
Inventory Control.
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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