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Professional Advisor Profile

This form (PAP) is maintained in the confidential files of Children's Hospital Foundation for use in communicating with professional advisors who work with and support the development activities of Children's Hospital Foundation on behalf of Children's National Medical Center and to provide recommendations to donors who need professional assistance. No information on this form will be released or recommendation made to donors without the approval of the advisor in the approval section of this form.

Please note: All highlighted and starred (*) fields are required.

Name: *
Name of Company/Firm*
Office Mailing Address: *
City/State/Zip: *
E-Mail: *
Telephone: *
Assistant Phone:
Assistant Email:

Professional Specialty

Financial Planner
Securities Broker
Trust Officer

Specialty Practice Areas (check all that apply): 

Real Property, Probate and Trust
Charitable Planning
Corporate Tax

Number of years in practice:

Undergraduate degree Year awarded College/University
Graduate degree Year awarded College/University
Designations, Awards Year awarded Issuing Entity
Designations, Awards Year awarded Issuing Entity

Number of professionals in firm:
26-50 51-100 101+

Are you a member of:
an Estate Planning Council?
The National Capital Gift Planning Council?

Other professional affiliations? Please describe:

Please describe how you would like to be involved with Childrens National.

Yes, I would consider hosting a Professional Advisors' Breakfast. Please contact me.

YES, you have my permission to release information on this profile to potential donors as a referral for professional services until otherwise notified in writing. I understand this form will be updated periodically, and I can withdraw my permission at any time.

NO, you do not have my permission to release information on this profile to potential donors as a referral for professional services. I reserve the right to authorize the release of that information in the future.

The material presented on this Planned Giving website is not offered as legal or tax advice.
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