CSC Gift Recipient Informatiom Form

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This field is for validation purposes and should be left unchanged.

A. RECIPIENT INFORMATION

Full Name(Required)

NCSU ID (student/employee ID NUMBER) (if applicable)(Required)

If you are a student/NCSU employee do not enter your unity ID. Your student or employee ID number is required.

NCSU Affiliation(Required)

Important: If you are both an NC State student and an NC State employee (TA/RA/Grader/student worker), select Employee.

Citizenship(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

B. GIFT DETAILS

Is this a research incentive?(Required)

Yes

Type of Gift(Required)

Store/Brand Name of Gift Card(Required)

Description of Gift if "Other"(Required)

Ex. Apple Airpods, CSC Clothing, Wireless Speakers

Gift Amount(Required)

Enter the total value of the gift you received.

Date Gift was Received(Required)

Name of Gift Distributor(Required)

Enter the name of the person who gave, handed, or electronically sent the gift to you.

Email of Gift Distributor(Required)

Enter the email address of the person who gave, handed, or electronically sent the gift to you. They will receive confirmation when this form is submitted.

Was this gift paid from a research/grant project?(Required)

Yes

If the gift was paid from a research grant/project number beginning with “5,” select Yes. Otherwise, select No.

Research Grant Project Number(Required)

Enter the project number used to purchase the gift. Research grant project numbers begin with “5.” If you do not know the project number, contact the person who provided the gift before submitting this form.

Project Number(Required)

Enter the project number used to purchase the gift. If you do not know the project number, contact the person who provided the gift before submitting this form.

ACKNOWLEDGEMENT

Gift cards and gift certificates are considered cash equivalents and are taxable income regardless of their dollar value. Awards, gifts, and prizes may be subject to applicable federal and state tax reporting and/or withholding requirements based on the type of gift, the recipient’s relationship with NC State, and the recipient’s tax residency status. By checking the box below, I acknowledge that I have read and understand the information above and confirm that the information I provided on this form is accurate.

Acknowledgement(Required)

I acknowledge and agree.

CSC Gift Recipient Informatiom Form

A. RECIPIENT INFORMATION

B. GIFT DETAILS

ACKNOWLEDGEMENT

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