Acceptance Request for Gifts of Equipment or Materials

Also known as the Gifts-in-Kind Form

Please complete this form for any item valued at $1,000 or more and for all gifts involving hazardous materials regardless of value.

Materials or equipment may not be delivered to WPI prior to the submission of this form and department head approval. Any and all materials received become the property of the university and do not belong to any individual. For more information, please refer to the WPI Gifts-in-Kind Policy.

If you need help completing this form please contact your department head.

When you submit this form, a copy is automatically transmitted to your department head, as well as to any offices involved in authorizing the gift acceptance (e.g., Safety Officer of gifts involving hazardous materials). Certain offices requiring additional information may contact you.

Required fields below are marked with an asterisk (*).

* Reporting Department/Division
* Your Name
* Your E-mail
* Donor (name of company/individual)
Donor's Title
* Gift is From corporation
a WPI alumnus/a? Yes
government agency
* Donor's Mailing Address (for acknowledgement)
Donor's Phone
Donor's E-mail
* Description of Gift

Please include details such as model numbers if appropriate, and note condition of gift if used.

* Gift Use

A brief description of research and/or educational activities that will utilize and benefit from the gift-in-kind. Please mention particular projects or courses in which the gift will be used, if applicable.

* Is this a Company Product? Yes No
* Is this New or Used Equipment? New Used
Gift Properties Please check all that apply
Computer Software (if checked, see the section on software below)
Computer Hardware
Network Hardware
Scientific Apparatus
This is a gift
Obtained under contract
Personal property such as art, books, collectibles
Material for WPI Archives
Please complete this section for gifts of Computer Software only Number of licenses or seats:
Additional staff required? Yes No
If license, what is the duration?
Is training required to use this software? Yes No
Who will maintain the software? IT Staff Dept Staff
Please check if this item involves any of the following Restricted to particular use
Moving, delivery, or installation costs
Shipped from outside the U.S.
Fees or maintenance costs: $
Additional space, renovations, or alterations
Human subjects
This item must be returned in the future
Training is required
* Gift Value
See valuation)
* How was gift value determined?

(Note: The Development Office can help determine value.)

* Date of Gift (mm/dd/yyyy)
Expected Delivery Date (mm/dd/yyyy)
Send Copy to me:
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Last modified: June 14, 2007 09:25:35