BPI Gift Commitment Form

I/we wish to support the work of the Black Philanthropy Initiative and make the following commitment:

A total gift of $ total gift amount* to the Black Philanthropy Initiative Fund. This commitment will be fulfilled as follows:

Please select all that apply*

A one-time contribution.A one-time grant payable from my/our donor-advised fund at The Winston-Salem Foundation.A two-year commitment.A two-year grant payable from my/our donor-advised fund at The Winston-Salem Foundation.Contact me about making a gift of appreciated stock, a distribution from an IRA, or another asset.I/We would like to remain anonymous.I/We would like to discuss including the Black Philanthropy Initiative in future gift plans.

My one-time contribution will be made by the following date:

enter date above

For my one-time contribution, I will:

Mail a check to The Winston-Salem Foundation with BPI noted in the memo line.Make a donation on bpiws.org.Other

My multi-year commitment will be payable over

2 years3 years

First payment of $ first payment amount will be made by the following date: Date . (Please note: Pledge reminders are sent annually in October.)

Please send me an annual pledge reminder.

YesNo

My multi-year grant payable from my/our donor-advised fund at The Winston-Salem Foundation will be payable over

2 years3 years

Fund Name

Please schedule these grants from my donor-advised fund with the first payment on month year

Please schedule this one-time grant from my donor-advised fund with the payment on month year

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How do you self-identify? (optional)

Asian American/Pacific Islander/AsianBlack/African American/AfricanHispanic/Latino/Latina/LatinxNative American/American Indian/IndigenousWhite/Caucasian/EuropeanMulti-racial/Multi-ethnicDifferent identity (please specify)

BPI Gift Commitment Form

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