1 EXAMPLE Facility (Copy of Facility Naming Agreement & Letter of Intent must be attached) Program (Copy of Letter of Intent must be attached) NORTH CAROLINA STATE UNIVERSITY REQUEST FOR APPROVAL OF DONOR NAMING PROPOSAL PROPOSED NAME: John Doe Engineering Building II DESCRIPTION OF THE FACILITY OR PROGRAM TO BE NAMED: Located on Centennial Campus, this building is one of 3 new Engineering buildings built using funds from the 2000 Bond Education Program. It houses the Computer Science and Electrical & Computer Engineering Departments. Built in 2005. Sq. Footage 202,376 DATE OF GIFT (RECORDED): June 1, 2009 BENEFACTOR CONTRIBUTION AMOUNT: $5,000,000 GIFT TYPE: A 5-year pledge to establish an endowment for unrestricted support – the pledge is to be paid in 5 equal installments using outright cash and securities. Please see attached signed Facilities Agreement. PURPOSE: John Doe has established an endowment in the North Carolina State University Engineering Foundation for unrestricted support of the College of Engineering Departments of Computer Science and Electrical & Computer Engineering. RATIONALE FOR NAMING PROPOSAL/DONOR RELATIONSHIP WITH NC STATE UNIVERSITY: John Doe is a 1959 graduate of NC State University with a BS in Computer Engineering. He currently serves on the Board of Visitors and has served on the NC State University Engineering Foundation, and NC State Univ. Student Aid Association Foundation. ___________ Name and Title of Nominator (please print) _________________________________________ Signature of Nominator (no electronic signatures) _________________________________________ Signature of Supervising Dean or Executive Officer ________________ Date ________________ Date I certify that this naming proposal and any accompanying agreement(s) comply with NC State University and UNC Board of Governors’ policies. ___________________________________________ Vice Chancellor for University Advancement ________________________ Date Completed forms and any additional materials should be provided to the Vice Chancellor for University Advancement, 2 EXAMPLE Box 7004. The naming proposal will be submitted to the Special Committee on Donor Namings for discussion before a recommendation is made to the Chancellor. Following approval by the Chancellor, the naming proposal is submitted to the NC State Board of Trustees' Development Committee and the full Board of Trustees for final approval. APPROVED NOT APPROVED _________________________________________ ___________________________ Associate Vice Chancellor for University Development Chair of Special Committee on Donor Namings Date of Review by Committee If not recommended for approval, please attach rationale for Committee decision. Revised 7/15/09