Declaration of Intent Form

Is Cal Poly in your will?

Gift and Bequest Designation

The information in this form is considered confidential by the Office of Planned Giving and protected by university policy. The information you provide will be used only to assure your gift is directed towards your desired purpose and to provide recognition of your gift if you choose. If you need to reach us, please contact us at 805-756-7125 or plannedgiving@calpoly.edu.

My Estate Includes Cal Poly

I have provided support for the mission and goals of California Polytechnic State University in my estate plans. By sharing this information, I understand this future commitment can be modified or revoked at any time.

About You

Donor Information

First Name Required Field

Last Name

Recognition Name (if different)

Primary Email Required Field

Primary Phone

Birth Date (MM/DD/YYYY)

Home Address

City, State Zip

Second Donor Information (if applicable)

First Name

Last Name

Recognition Name (if different)

Birth Date (MM/DD/YYYY)

The Gift

Type:

Type: Bequest from will or living trust
Beneficiary of IRA or other retirement plan
Life insurance
Other
I have not yet included Cal Poly in my estate please send me information.

The estimated value of this gift as of today's date is: $

This commitment is to be used for:

This commitment is to be used for: The priority needs of California Polytechnic State University
The priority needs of (college/unit/department/program)
Creating a named endowment
Other

Enter your gift designation here:

Attach letter of intent or additional sheets if necessary. You may wish to attach a copy of related trust or will pages identifying Cal Poly as a beneficiary (optional).

File Upload (10MB or less):

Supported file types: PDF, DOCX or JPEG

Recognition

Please Choose:

Please Choose: Please include me without disclosure of amount in the Cal Poly 1901 Legacy Society.
I do not want my name published and wish to remain anonymous in perpetuity.
I do not want my name published and wish to remain anonymous during my lifetime(s).

This statement is an expression of my current plans and may be revoked. I understand that this statement is not legally binding on my estate and that this information is solely for university use to facilitate proper application of my gift at the time it arrives. I understand all planned and deferred gifts are subject to the administrative fee in effect at the time the gift arrives.

Signature:

I/we understand that by entering in my/our name in this box, I/we are signing this agreement electronically and agree this electronic signature is the legal equivalent of my/our manual signature on this agreement.

This is a Blueprint template.