Fund Allocation Worksheet by n0pnf7


									                                                                    Fund Allocation

Thank you for your interest in establishing a Fund at First Candle in memory of a baby. The First
Candle Fund will give you and your family a special, meaningful way to remember your loved
one year after year and will further critical programs to help all infants survive and thrive.

W ays to Establish the Fund

Donations can be generated through an annual mailing to your friends, family and colleagues or
they can be initiated as part of a special event or memorial service. Memorial funds can also be
established simply by a yearly contribution. First Candle will send acknowledgements to you of each
donation that we receive for the fund.

W hy a Fund with First Candle?
We know that you have many options when it comes to determining where you will focus your
fundraising and philanthropic efforts. At First Candle, we pledge to remain true stewards of your
contributions. Recently ranked as one of the top charities in the nation by the American Institute of
Philanthropy, First Candle also meets all guidelines as set forth by the Better Business Bureau and is
listed in its Wise Giving Guide. We are proud of our ongoing record of maintaining administrative
costs below the industry standard of 25 percent.

Upon com pletion, please fax or mail this form to First Candle at 410.653.8709 (fax)
            or 1314 Bedford Avenue, Suite 210, Baltimore, M D 21208.

Your Name                                          The Baby’s Name

Street Address

City, State Zip

Phone                                              Email Address

Birth Date                                         Angel Date

Event Name, if applicable                          Event Date, if applicable
I am a (check one please):
   SIDS Family Member                  Stillbirth Parent                     Other Infant Death Parent
   SIDS Grandparent                    Miscarriage Parent                    Other Infant Death Family
   SIDS Parent                         Miscarriage Grandparent             Member
   Stillbirth Family Member            Miscarriage Family                    Other Infant Death
   Stillbirth Grandparent            Member                                Grandparent

May we acknowledge your fund in our annual report and on our website?
                                 ___ Yes     ___ No

Would you like to establish a Memorial Fund at First Candle in your Baby’s Name?
                                     ___ Yes      ___ No

Directing Your Contribution

To focus our efforts and minimize administrative costs, First Candle respectfully requests that
  families allocate the donated funds to one or more of the categories listed below. The
         money directed to your fund will be spent each year as allocated below.

          Education and Fam ily Support Fund. Through this fund we supply comprehensive, up-
          to-date information on infant health and survival to new and expectant parents and health
          professionals through 24/7 toll-free help line, public education campaigns, trainings and our
          website. Our goal is to help parents and other professionals reduce the risk and safe infant
_______   lives.

          In addition, through support groups, conferences, our 24/7, toll-free crisis line as well as
          training peer contacts, we help bereaved families connect, share experiences and get the
          help, information and referrals they need to start their journey of healing.

          M edical Research and Advocacy Fund. Our national research program ensures
          funding of projects that meet the highest standards of scientific merit and medical
          significance. Currently, we are funding projects at Boston Children’s Hospital/Harvard
          University and San Diego Children’s Hospital. Along the same lines, our advocacy efforts are
          aimed at guiding political action to ensure that Federal programs such as the National
          Institute for Child Health and Human Development, the Maternal and Child Health Bureau
_______   and the Centers for Disease Control & Prevention receive adequate funding to support
          forward progress in the fight to save infant lives.
          Please select one:

          ___ SIDS Research       ___ Stillbirth Research
          Special note: At First Candle, at least 90 cents of every dollar donated to our Medical Research and
          Advocacy Fund is given directly to support our researchers and their projects. The balance (as
          determined by our annual audit) is used by First Candle to oversee and administer this Fund.

          Unrestricted. This category provides critical unrestricted funds that help support critical
_______   staff functions including administration, technology and other administrative needs. Without
          support for these functions, First Candle would be severely hampered in its mission.

100 %     TOTAL

Signature: _________________________________________                     Date: __________________

For more inform ation on First Candle’s M em orial Fund program or to receive
bereavem ent m aterials or support, please contact First Candle at 800.221.7437.

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