Giving to UAM

* indicates required fields.

Donor Title: Mr. Ms. Dr. Rev.

*Donor First Name: 

Donor Middle Name or Initial: 

*Donor Last Name: 

*Select Parent, Friend, Alumna or Alumnus:   Parent Friend Alumna Alumnus

Please indicate class year if Alumna/Alumnus: 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928

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

Please indicate class year of spouse: 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928

*Address (line 1): 

Address (line 2):  

*City:  

*State:  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Zip:    

*This is my:  Home Address Business Address (home/business) address

E-Mail Address: (required for email receipt)

*Phone:  (ex. 999-999-9999)

Gift Amount and Designation

*Gift Amount: $ 

Please designate my gift to: Phonathon-Opportunity Fund Athletics - General Campaign for Athletics Centennial Circle College of General Studies College of Technology - Crossett College of Technology - McGehee Division of Agriculture Division of Computer Information Systems Division of Nursing Music School of Arts and Humanities School of Business School of Education School of Forest Resources School of Science and Mathematics School of Social and Behavioral Sciences Library General Scholarship Area of Greatest Need Other (enter description below) (choose an area department, or Phonathon)

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

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:   

Gifts of Securities

I am interested in making a gift of securities. Please call me with more information.

Next year, would you prefer to be contacted for an Annual Fund gift by e-mail?
      Yes No

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.