To:  Community Foundation of Northwest Georgia Grants Committee
       P.O. Box 942, Dalton, Georgia 30722-0942
       Phone 275-9117  
       Fax 275-9118

From: _____________________________________________________________

Re:    _____________________________________________________________
        (Name of the Donor Advised Fund)

I recommend that the Grants Committee review and approve the following distributions from the fund listed above.  I understand that the final judgment rests in the hands of the Grants Committee whose charge it is to see that all distributions are within the purposes of the Community Foundation of Northwest Georgia, Inc.  I acknowledge that the requested recommendations do not represent the payment of any legally enforceable pledge or obligation nor does the undersigned expect any goods or services as a result of this charitable distribution.

Signature and Date       

Name, Address, and Phone of Recipient Organization     Suggested Grant Amount

________________________________________         $ __________________
Phone ____________________