UNIVERSITY OF WISCONSIN-STOUT
TRANSMITTAL FORM FOR ACCEPTANCE OF GIFT OF MONEY
Print on Green Paper
Anticipated Award will be:
Official Account Title
Funding Source:
Account Code
Transmittal Date:
Funds Requested: GOM
RS Project #
233
All gifts of money must be deposited to the University and be formally accepted by the University to comply with all fiscal accountability requirements established by
the University of Wisconsin System. To qualify as a gift of money, all of the following conditions must prevail. Please initial each item to assure compliance.
________ (1)
________ (2)
________ (3)
________ (4)
________ (5)
Funds received are unrestricted.
Detailed reports, program and/or fiscal, are not required.
No provisions are imposed concerning publications.
No specific time limit is designated.
Patents and/or copyrights are not retained by the donor.
________ Check here if this is a recurring gift.
To comply with University of Wisconsin System policies, the following information and procedures are required.
1. Conditions or restrictions:
2.
Use of Gift of Money:
3.
Donor:
Contact Person:
Address:
4.
5.
Negotiator:
College:
Signature:
Date:
Date Received:
Dept.:
6. Amount of Gift of Money:
Accounting Services Use Only:
Major/Minor: _______ _______
Comments:
Account Release: ____________________
Agency: _______________________________________Revenue Category: ___________________
24 characters maximum
Activity Code Comments: ____________________________________________________________
By signing this form you are authorizing the project,
the account request and certifying that to the best of
your knowledge this project is in compliance with the
UW-Stout Conflict of Interest Policy.
Provost - required if $1,000 or greater
Date
These names are listed for informational purposes.
Budget Officer
Acct Administrator #1
Acct Administrator #2
Account Supervisor #1
Account Supervisor #2
Contact Person and Ext.
Department Chair
Date
Dean/Unit Supervisor
Research Administrator
Date
Vice Chancellor ASLS
Chancellor - required if $5,000 or greater
Date
Classified
LTE
Unclassified
State Pay/Work study
Grad Assistant
Fringe Benefits
Service & Supplies
Capital
Special - Aid
Special - Interest
Sales Credit
Indirect (233/244)
Travel (244)
TOTAL
Ref
Number
51100
51200
51300
51400
51500
52000
53000
54000
55000
55100
56000
57000
58000
Submitted
Budget
Date
Date
Actual
Budget
Increase
BPA
FTE
HR__________Date____________BFS___________Date___________
Revised 3/6/2012
Please complete and forward this form to Research Services, 152 Vocational Rehabilitation Building. No
expenditure of the funds received as a gift of money will be processed until the formal acceptance of the gift has
been completely approved. It is also important to respond promptly to donors.
If you have questions, please call Research Services at x1126.
Procedures for Accepting Gifts of Money
and
Instructions for Use of this Form
Gifts of money are defined as monetary awards offered to the University and must meet the five criteria described
on the front of this form.
Restricted-Unrestricted: The test of "restrictiveness" for a gift of money is based upon IRS interpretation. If
excessive restrictions or conditions are placed on the gift, it ceases to be considered a gift by the IRS. Designating
a gift of money for use by a specific department, college, or existing program is acceptable and meets the test for
being unrestricted. Even when meeting the test for being unrestricted, some conditions might still be imposed by
the donor. List these under item 1. Conditions or restrictions.
This form must be completed and approved prior to the actual acceptance of all gifts of money. This form may be
initiated by any member of UW-Stout faculty or staff involved in negotiations for such a gift. UW System policy
requires that the Chancellor approve all gifts accepted by the University. At UW-Stout, the responsibility for
accepting gifts of money with a value of less than $1,000 has been delegated to the Research Administrator, gifts
with a value of $1,000 to $4,999 has been delegated to the Provost and gifts with a value of $5,000 or more are the
responsibility of the Chancellor. The acceptance of gifts of money is handled through this process.
Business and Financial Services will report gifts of money to the Board of Regents for acceptance by the
University of Wisconsin System.
A letter of acknowledgement will be generated routinely by Research Services for gifts of money, other than those
that come through the Stout Foundation.
Distribution of this form after completion is also made by Research Services. Copies are forwarded to:





Negotiator
Department Chairperson
College Budget Officer
Dean
Business Office
NOTE: All gift of money payments from the Stout University Foundation to UW-Stout require a
payment request form to be completed and sent to Accounting Services, 125 Administration Building as
part of the gift of money process. The form is available on the Administrative and Student Life Services
website under forms.
Revised 3/6/2012