The Graduate College of Social Work: Scholarship Luncheon 2017 "Rising Strong" Tuesday, March 7, 2017 11:30 AM - Registration 12:00 PM - Lunch and Program Give Online Now I would like to make: a new one time or recurring gift a payment on an existing pledge * Frequency: One time Weekly Monthly Quarterly Annual Recurring Amount: $ Start Date: End Date: If you would like to split your recurring gift between multiple colleges and/or programs, please specify below. * I would like to make a gift to benefit the following: 2017 GCSW Scholarship Luncheon: $50,000 Rising Strong#$ $25,000 Daring Greatly#$ $10,000 I Thought it Was Just Me#$ $5,000 The Power of Vulnerability#$ $2,500 The Gifts of Imperfection#$ $1,000 Patron Couple#$ $500 Patron Single Ticket#$ $250 Individual Ticket#$ Registration Total: $ I'd like to make a gift to benefit GCSW: Deans Excellence FundMSW ScholarshipsPh.D. ScholarshipsOther $ To make an additional designation, please do so below: Alliance Management Institute (AMI) Conference CampaignAustin Legislative Internship ProgramBilingual MSW Scholarships - Spanish LanguageBilingual MSW Scholarships - Asian LanguagesCatherine Tuong So Lam Memorial ScholarshipCheryl Vetter Memorial ScholarshipCheung & Leung PhD EndowmentGCSW Student Association Scholarship EndowmentMark Magaziner Memorial FellowshipPhD EndowmentSandra A. Lopez Scholarship Endowment Excellence in Clinical David M. Underwood Nonprofit Leadership Alliance ProgramR. J. DeBottis Memorial ScholarshipOther $ Total gift amount: $ Please let us know if you would like to designate your gift further (for example, to a department within a college or in honor or memory of someone) or give us any other special instructions about yourgift. This gift is in memory of: This gift is in honor of: Donor Information Title: Please choose... Airman First Class Baron Brigadier General Captain Colonel Dean Doctor Father First Lieutenant General Governor Judge Lieutenant Lieutenant Colonel Lieutenant Commander Major Miss Mr. Mrs Ms. Professor Rabbi Sargeant Sargeant Major Sister Sister The Honorable The Most Reverend The Reverend * First name: Middle name: * Last name: Suffix: * Address: * City: * State: * Zip code: * Country: * Phone number: * Email address: Date of birth: Spouse's full name: Alumnus status: UH Alumnus UH Student Neither UH degree: Graduation year: * Peoplesoft ID: Matching Gifts Did you know you can double or triple your gift if you or your spouse work for a company with a matching gift program? Learn whether your employer has a matching gifts program. You may also contact your Human Resources Department directly. Do you or your spouse work for a matching company? Yes No I work for a matching gift company Company name: My spouse works for a matching gift company Spouse's company name: Send your completed matching gift form to: Matching Gift Administrator Gift Processing and Records University of Houston Houston, TX 77204-5035 Business Information Please help us keep your record up to date. Would you like to update your business information? Yes No Job title: Employer: Address: City: State/Province: Zip/Postal code: Country: Phone number: Email address: Planned Giving Have you already or would you like to include UH in your estate planning? Yes No I have already included UH as a beneficiary of my: Will Trust Life Insurance Policy Retirement Assets Annuity IRA Please send me information for the following: Bequest Language Membership in The Tempore Legacy Society Ways to Make Planned Gifts Charitable Gift Annuities Estate Planning Kit Click below to enter credit card details Information provided on this form will be used by the university's Office of Development for the purpose of crediting you correctly for your gift. Personal information contained in the Office of Development's records is used only for university business. We are committed to protecting your privacy. Our secure server software (SSL) is the industry standard and among the best software available today for secure commerce transactions.