OLE MISS

Charitable Donation Request Form

*Organization Name:

*Organization's Website:

*Contact name:

*Address, City, State, Zip:

*Phone Number:

*Email:

*What is the intent of the charitable donation?

*Is this organization a 501 (c) (3) nonprofit agency?
Yes
No

*What is EIN (Tax ID) for your organization?

*What kind of organization is this?
Charitable
Educational
Institutional

*What age group does this organization benefit?
K-8th Grade
High School
Adult

*From what sport head coach would you like an autographed ball?
Football
Men's Basketball
Women's Basketball
Baseball
Men's Golf
Women's Golf
Rifle
Soccer
Softball
Men's Tennis
Women's Tennis
Volleyball
Track & Field/XC

*Will the autographed item:
Be purchased from the Rebel Shop
Be mailed/dropped off at the athletics department

NCAA guidelines require that the following conditions be met in regards to institutional memorabilia and autographs:

  1. The requested item may not be used in fundraising events for any high school organization, high school fund raising event that will benefit a charity or educational project or any high school or prospect-aged individual. High school is defined as grades nine through twelve.
  2. All monies derived from the promotions activity or project must go directly to the charity, non-profit agency or educational institution listed above.
  3. The requested item involving student-athlete’s names may not involve co-sponsorship, advertisement or promotion by a commercial agency other than a company’s logo or trademark on printed materials.
  4. An authorized representative of the agency must sign a waiver agreeing to adhere to all NCAA guidelines regarding this request.
  5. Use of the memorabilia item must have written approval from the Athletic Compliance Office.
  6. Memorabilia may not be re-sold for any purpose without Athletic Compliance Office approval.

* Required Field