Gift Administration 9500 Gilman Drive, Mail Code 0940 Phone: (858) 534-8159 Fax: (858) 534-8160

Crowdfunding New Regents Gift Fund Information SheetDate**

Name of Fund**

VC Area** Department**

Division**

Crowdfunding Project Name, Purpose, and Restrictions**:

PI Name** Phone Number**

Mail Code** Email Address**

Business Officer Name** Phone Number**

Mail Code** Email Address**

Use**

Special Instruction:

Form Prepared by**

Please print this form for your records by clicking "Print Form" before clicking "Submit by Email". Attention Mac Users: Please print and mail to us at MC 0940

Go-Live Date **

Phone #**

Email Address**

Department Support

Research

Required items are noted with **

mm/day/year

Length of Crowdfunding Campaign **

# of Days

Fund Number Assigned by Gift Administration:

Index Prefix** Org #** Program #**