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Fiat Lux Legacy Society Gift Intention Form

Fiat Lux Legacy Society Gift Intention Form

Thank you for generously considering a bequest to Clark University. Please let us know about your estate gift legacy plans by completing this form. Your documentation will help us ensure that your gift legacy plans are fulfilled and allow us to recognize your generosity. The information you provide is confidential and disclosing your gift legacy plans does not create a legally binding pledge.

Donor information

Name(Required)

First Last

Email(Required)

Phone(Required)

Graduation Year(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Spouse Name

First Last

Spouse Email

Spouse Phone

Spouse Class Year (if Clark graduate)

Date of Birth

MM slash DD slash YYYY

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gift information

Please share this form with those involved in your estate planning. Clark University is a charitable organization organized under section 501(c)3 of the Internal Revenue Code and is exempt from federal income taxation. The University’s federal tax identification number is 04-2111203. Any supporting documentation can be shared with Clark’s Planned Giving office by fax or email at Krafey@clarku.edu (optional).⁠

I/We Have Included a Gift to Clark Via My/Our:(Required)

Will of revocable trust

Retirement plan (e.g. 401k, 403b, pension and/or IRA)

Charitable gift annuity

Charitable remainder trust

Life insurance policy

Other

When my/our gift is received, it is my/our wish that Clark use these funds for the following purpose(s):

Unrestricted-All contributions to The Clark Fund are deemed current use, meaning that they are used immediately to enhance our student experience and support our esteemed faculty.

Restricted for the following purpose(s): *

Restricted for the following purpose(s): *

*If, in the future, it becomes impossible or impractical to use my/our gift as described above, I/we understand that Clark University’s Board of Trustees may use my/our gift as they judge best and as consistently as possible with my/our wishes. Please talk with Clark’s Planned Giving Office if you would like your gift to create a new endowed fund or if it is narrowly restricted.

Gift intention(Required)

I/We intend to leave a predetermined monetary amount to Clark University

I/We intend to leave a percentage of the asset(s) indicated above.

I/We intend to leave the residuary of my/our estate to Clark.

I/We intend to leave specific property to Clark (enter description and estimated value below)

Estimated Amount

Description of property and estimated value

Untitled(Required)

Upon my death

Upon the death of my spouse if she/he/they survives me

Other

Do You Prefer Your Gift to be Anonymous?:

I/We wish to be anonymous member(s) of the Fiat Lux Legacy Society

Please list my/our name(s)

Clark’s Fiat Lux Legacy Society honors alumni, parents, and friends who have demonstrated their commitment to Clark’s future by establishing planned gifts or including the University as a charitable beneficiary of their estate plans.

Please list my/our name(s) as follows:

Δ

Contact information

Alumni and Friends Engagement

Office location

Clark University
950 Main Street
Worcester, MA 01610

1-508-793-7166

1-800-793-6246

alumni@clarku.edu

Invest in the next generation of Clarkies.

950 Main St, Worcester, MA, USA • 508-793-7711

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