University of Arkansas at Monticello
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Donor Title:

* Donor First Name: 

Donor Middle Name or Initial: 

* Donor Last Name: 

* Select Parent, Friend, Alumna or Alumnus:  

Please indicate class year if Alumna/Alumnus:

If this is a joint gift, enter spouse's name: 

Please indicate class year of spouse:

* Address (line 1): 

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* This is my:  (home/business) address

* E-Mail Address:

* Phone:  (ex. 999-999-9999)


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Gift Amount and Designation

* Gift Amount: $ 

Please designate my gift to:
(choose one from the list)

I would like to specifically designate my gift to the following department or program:

Honor/Memorial Gift

I would like to make this gift in (honor/memory) of: (Name or Occasion)

Please send acknowledgement to:

Name:     
Address:  
City:        
State:     
Zip:         

Matching Gifts

Did you know that a matching gift can double or triple your gift? Many companies will match gifts made by their employees or their spouses. Please check with your employer to determine if a matching gift program exists! If so, please send the matching gift form to:

University of Arkansas at Monticello
Office of Advancement
P.O. Box 3520
Monticello, AR 71656

I work for a matching gift company and will submit my form to UAM

Name of Company:   


Confidentiality Statement:
The University of Arkansas at Monticello is very concerned with the security of financial information and transactions on the Internet. The information submitted on this form is protected by a secure server. Information submitted on this form is for the use of UAM only and will not be shared with any outside individuals.

Questions?
Please call or write the Office of Advancement at:

P.O. Box 3520
Monticello, AR 71656
870-460-1028

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