Gift # 1 - College, Center or Institute:  --Select from List--Area Health Education CentersArkansas Cancer Research CenterCollege of MedicineCollege of Health Related ProfessionsCollege of PharmacyCollege of NursingCollege of Public HealthGraduate SchoolJones Eye InstituteMyeloma InstitutePschiatric Research Instit.Reynolds Institute on AgingStephens Spine InstituteUAMS Medical Center $

(Optional) Please designate your gift to an established UAMS Foundation fund. Check with your Development Officer to determine a fund name. If you don’t have this information, please note the specific Department, Area, Program or Scholarship. If no area is designated, your gift will be placed in the area of greatest need.

Gift # 2 - College, Center or Institute:

(Optional) Please designate your gift to an established UAMS Foundation fund. Check with your Development Officer to determine a fund name. If you don’t have this information, please note the specific Department, Area, Program or Scholarship. If no area is designated, your gift will be placed in the area of greatest need.

Gift # 3 - Area of Greatest Need:

$

TOTAL

$

Step 2: Designate gift # --Select--12 as an Honor or Memorial gift.
If you would like to designate multiple gifts as honor or memorial gifts, please inform us in the Comments section below.

My gift is:

  In Honor of 

  In Memory of 

Please provide the names and addresses of anyone that should be notified of your gift.
Name 1: Address 1:

Name 2: Address 2:

Step 3: Find out if your gift will be matched by your employer.

Many employers sponsor matching gift programs and will match any charitable contributions made by their employees. To find out if your company has a matching gift policy, please click on the link below.

http://www.matchinggifts.com/uams

If your company is eligible, please follow the provided directions to make your gift. The impact of your gift to our organization may be doubled or possibly tripled! Some companies match gifts made by retirees and/or spouses.

Step 4: Provide your Personal Information.

* Indicates a required field.

  Dr.   Mr.   Mrs.   Ms.   Miss

*

First Name: 

Middle Initial: 

*

Last Name: 

Address1:*

Address2:

*

City, State:    --Select From List--N/AAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

*

Zip Code:  - ( optional)

*

Area Code - Telephone: 

*

E-mail Address: 

(Optional) Step 5: If you are employed by UAMS, please provide your work information.

Primary Work Area   --Select from List--Academic Affairs and Research AdministrationAdministration and Government AffairsArea Health Education CentersArkansas Cancer Research CenterBudget and PlanningCampus OperationsCollege of MedicineCollege of Health Related ProfessionsCollege of PharmacyCollege of NursingCollege of Public HealthCommunications & MarketingDevelopment and Alumni AffairsFinancial AdministrationGraduate SchoolReynolds Institute on AgingInformation TechnologyJones Eye InstituteMyeloma InstitutePsychiatric Research Instit.Regional ProgramsStephens Spine InstituteSupport ServicesUAMS Medical CenterOther

Department or Division 

Comments: