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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:

I would like to remove an individual from the above program account

Name: Reason for Removal:

I would like to add an individual to the above program account with complete access as an Advisor

Name: Email:

Address: Contact Number:

City: State:

Zip:

I would like to remove myself as Program Manager, and propose a replacement below:

New Program Manager Information:

Name: Email:

Address: Contact Number:

City: State:

Zip: SSN:

Reason for Removal:

Signature of new Program Manager: May 30, 2023

***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:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

April 26, 2021 4:01 pm EDT

Amendments to Program Form Uploaded by Fiscal Sponsorship - fsp@unitedcharitable.org IP 108.28.172.231

May 11, 2021 3:42 pm EDT

FSP User - fsp@unitedcharitable.org added by Fiscal Sponsorship - fsp@unitedcharitable.org as a CC'd Recipient Ip: 108.28.172.231