I hereby name the University of Wisconsin-La Crosse Foundation Inc., hereinafter known as the Foundation, as the owner and beneficiary of my _[NAME OF INSURANCE COMPANY]_. Policy # _____________ with a face value of $____________________. I designate that upon my death, the proceeds will be distributed to the Foundation.
This gift shall be for the further benefit of the ___[COLLEGE, PROGRAM]__. Funds distributed from this life insurance policy shall be used to provide ___[PURPOSE]__. If this gift is for the creation of an endowment, then the terms of the endowment should be set forth in a separate letter of instructions, to be referenced by the beneficiary designation forms.
Additional information for designation form:
Tax ID Number: University of Wisconsin-La Crosse Foundation Inc. 39-1145116
Mailing Address: the UWL Foundation Inc.
Cleary Alumni & Friends Center, 615 East Avenue, North, La Crosse, WI 54601