You must have JavaScript enabled to use this form. Name Email Phone Number Address Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Intended Gift Purpose The anticipated or estimated value of my gift is $ I/We have made the following provision for a gift: Bequest Retirement Assets Life Insurance Donor Advised Fund succession plan Charitable Remainder Trust Charitable Lead Trust Other Please specify. In recognizing this gift, the College is authorized to acknowledge in its publications the following planned giving donors as members of the Charles Wesley Emerson 1880 Society: Donor Name(s) I/We have made provision for a gift, but prefer confidentiality and do not wish to be listed as a member of the Charles Wesley Emerson 1880 Society. I/We wish to consider a planned gift and would like to discuss giving options with the College’s gift planning staff. Please send me more information about the tax and other benefits of planned gifts. I have attached the following documentation in support of my gift (e.g. Copy of my Will (first/last and charitable bequest pages only); Beneficiary Designation Form, trust instrument, etc.): Upload Documentation One file only.100 MB limit.Allowed types: .txt, .rtf, .pdf, .doc, .docx, .odt, .odp, .ods, .xls, .xlsx. This “Statement of Intent” is confidential and non-binding. Leave this field blank