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: Your recurring gift will be split between multiple colleges and/or programs accordingly below. * I would like to receive: Quad Limestone Cube (FMV $89) # $ Quad Mailbox Door (FMV $25) # $ Preferred mailbox hall and room number *Please confirm your mailbox preference is still available by emailing Jeanette Miller at jmiller1@Central.UH.EDU. We cannot guarantee your preferred mailbox is available without this confirmation. Registration Total: $ I’d like to make an additional gift to benefit Student Housing and Residential Life $ Total gift amount: $ 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 Sergeant Sergeant Major Sister The Honorable The Most Reverend The Reverend * First name: Middle name: * Last name: Suffix: * Address: * City: * State/Province: * Zip code: * Country: * Phone number: * Email address: Date of birth: Spouse's full name: Status: UH Alumnus UH Faculty/Staff UH Student None UH degree: Graduation year: * Peoplesoft ID: Did you serve as a student or professional leader in housing? (check all that apply)             Professional Staff             Student Staff             Residence Hall Association (RHA)             National Residence Hall Honorary (NRHH) If you lived on campus, which building(s) did you live? (check all that apply)             Cougar Place             Cougar Village 1             Cougar Village 2             University Lofts             Bayou Oaks             Moody Towers             The Quadrangle     Do you want to sign up for our Student Housing and Residential Life Alumni Newsletter? (check for Yes) 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 University Advancement for the purpose of crediting you correctly for your gift. Personal information contained in University Advancement'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.