Amendments to Program Form

Program Name: Account #:  

This form should be used to notify of and seek approval for any changes in your program's management or mission statement. Select the section that applies to your desired action.

I. Change in or Addition to Program Management:

Name:  Reason for Removal:  

Name: Email:  

Address:   Contact Number:  

City:   State:


New Program Manager Information:

Name:   Email:  

Address:   Contact Number:  

City:   State:

Zip: SSN:  

Reason for Removal:  

Signature of new Program Manager: June 17, 2024

***Please attach a copy of the United Charitable Legal Agreement signed by the new Program Manager***

II. Revision or Change in Mission Statement:

I would like to change the program mission statement to (please attach separate sheet if necessary):

Reason for Changes:  

III. Revision or Change in Program Name: 

I would like to change the program name to:  

Reason for change:  

IV. Dissolution of Program:

Reason for closure:  

*If applicable, please also attach a completed disbursement request form directing the remainder of program account balance to a charity.


Leave this empty:

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Signature Certificate
Document name: Amendments to Program Form
lock iconUnique Document ID: 9497c84d6e54e69a351b39e27b3acc06752533ce
Timestamp Audit
April 26, 2021 4:01 pm EDTAmendments to Program Form Uploaded by Fiscal Sponsorship - IP
May 11, 2021 3:42 pm EDTFSP User - added by Fiscal Sponsorship - as a CC'd Recipient Ip: