Gift Acceptance Questionnaire

Name of faculty/staff ("Requesting Party"): Name of faculty/staff ("Requesting Party"): First Last
Requestor's Email Address:
Department of Requesting Party:
Manager or Supervisor of Requesting Party: Manager or Supervisor of Requesting Party: First Last
Gift Types

Provide details for all applicable categories
Merchandise gifts

Provide details about the merchandise being offered
Service gifts

Provide details about the services being offered
Food/beverage/accommodations/registration/tickets to sporting or other events

Provide details about the type of event, purpose, date, time location and the estimated value being offered
Compliance Forms / Please attach any forms to be signed.

Attach Files

Attach any Compliance documents or forms supplied by the vender/sponsor that require approval
Opportunity of chance (Raffles or Door Prizes)

Provide details about the raffle, game, lottery or other opportunity to win gifts/prizes
Other

Provide details about gift types that are not mentioned above
If this is an event (i.e., conference, luncheon, roundtable, etc.), please state the purpose.
Requesting Party is:

Requesting Party is: Employed in the Division of Finance (State Department/Unit employed) Finance/Acct. Director Business manager Personnel Official Grant Coordinator Legal Counsel in the Office of the General Counsel Vice President or Dean Reporting Individual (Files Financial Disclosure Form) Purchasing or Procurement Department Employee N/A Other (Please Describe)

Check all applicable boxes
Other:
The value of the gift or accommodation is:

The value of the gift or accommodation is: More than $100.00 $100 or less $100.00 or less and the value has been confirmed by the vendor
The gift/accommodation is related to work connected to a grant.

The gift/accommodation is related to work connected to a grant. Government grant Private grant N/A Other (Please Describe)
Other:
Name of Party Offering Gift:
Party Offering Gift is one of the following:

Party Offering Gift is one of the following: FIU Vendor Prospective Vendor Lobbyist to FIU Registered Lobbyist Political Committee N/A Other (Please Describe)
Other:
Requesting Party has the authority to do the following:

Requesting Party has the authority to do the following: Approve vendors or contracts for the purchase of goods/services by FIU over $10,000.00 in a fiscal year Recommend the use of specific vendors supplying goods/services to FIU over $10,000.00 in a fiscal year Authorized to make P-card purchases of $10,000.00 or more per fiscal year Sign contracts on behalf of FIU for contracts with a value of $15,000.00 or more per fiscal year N/A Other (Please Describe)
Other:
By checking this box, I confirm that the answers are true to the best of my knowledge, and that I have not used my position with FIU to influence official action to benefit the party offering the gift or accommodation.

By checking this box, I confirm that the answers are true to the best of my knowledge, and that I have not used my position with FIU to influence official action to benefit the party offering the gift or accommodation. I confirm.

Gift Acceptance Questionnaire

Gift Types