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* My name
* My email address
My spouse’s email address
Fund Name

Preferred mailing address
Street Address

City
State
    		 Zipcode

Second address
Street Address

City
State
    		 Zipcode
Telephone/fax/cell (indicate which)

Anonymity to grantees
You may release my name and address to grantees
Release only the Fund name to grantees, not my name or address

Fund listing in publications
You may list my Fund in your publications with the fund balance
You may list my Fund but not the fund balance
Do not list my Fund in your publications

Charitable Interests (check all that apply)
Aging
Animals
Arts & Culture
Basic Human Needs
Catholic Interests
Civic Engagement
Diversity
Early Childhood
Education
Environment
Families
Health
Historic Preservation
Jewish Interests
Neighborhoods
Sports & Recreation
Technology
Veterans
Women & Girls
Youth
Other

Rochester Area Community Foundation - 500 East Avenue - Rochester, NY - 14607-1912
(585) 271-4100