Please print and fill out this form, then mail it to: <br /> <br /> <strong>SIUE FOUNDATION<br /> CAMPUS BOX 1082<br /> EDWARDSVILLE IL 62026-1082</strong><br /> <br /> <br /> Name (Last): __________________________ (MI): ____ (First):_____________________<br /> <br /> Spouse (Last): _________________________ (MI): ____ (First):_____________________<br /> <br /> Address1: __________________________________________________________________<br /> <br /> Address2: __________________________________________________________________<br /> <br /> City: _________________________________ State: _________________ Zip: _________<br /> <br /> Home Phone: ___________________________ Email: ______________________________<br /> <br /> <br />There are numerous funds at the SIUE Foundation for the academic units, academic departments, and academic and University programs as well as various student award and scholarship funds. The following list represents some of the giving opportunities at the SIUE Foundation. To ask about a specific fund, please call Pat Mesnard at 618-650-2345. Gifts may be divided among funds. If you wish to designate your gift to multiple funds, please indicate the amount to go to each fund by the fund’s name.<br /> <br /> <br /><strong> Please direct my gift as follows:</strong><br /><br /><br /><table border="0" cellspacing="0" cellpadding="0"> <tr valign="top"> <td nowrap="nowrap">$ __________ </td> <td nowrap="nowrap">SIUE Advancement Fund</td> <td width="10" class="Bcaption"></td> <td class="Bcaption">(Gifts to the SIUE Advancement Fund may be used at the discretion of the SIUE Foundation’s Board of Directors to help meet campus priorities.)</td> </tr></table><br /> <br /><table border="0" cellspacing="0" cellpadding="0"> <tr> <td valign="top" class="xhdr">College and Schools</td> <td> </td> <td class="xhdr">Examples of University Programs</td> </tr> <tr> <td nowrap="nowrap" valign="top"> <p><br /><br /> $ __________ College of Arts & Sciences (03901)<br /><br /> $ __________ School of Business (03001)<br /><br /> $ __________ School of Dental Medicine (03101)<br /><br /> $ __________ School of Education (03201)<br /><br /> $ __________ School of Engineering (03301)<br /><br /> $ __________ School of Nursing (03601)</p> <p>$ __________ School of Pharmacy (03950)<br /><br /> $ __________ Lovejoy Library (04026)<br /><br /> $ __________ Graduate School (04048)<br /></p> </td> <td></td> <td nowrap="nowrap" valign="top"><br /> <br /> $ __________ Arts & Issues (04040)<br /> <br /> $ __________ Cougar Athletics (04060)<br /> <br /> or specify sport ____________________<br /> <br /> $ __________ East St. Louis Center (04080)<br /> <br /> $ __________ The Gardens (03715)<br /> <br /> $ __________ Student Affairs (04081)<br /> <br /> $ __________ University Museum (04017)<br /> <br /> $ __________ WSIE (04250)</td> </tr></table><br /><br /><br /> Examples of Scholarship and Faculty Research Programs<br /><br /><br /><table border="0" cellspacing="0" cellpadding="0"> <tr valign="top"> <td nowrap="nowrap">$ __________ </td> <td>Great Rivers Chancellors’s Scholarship Endowment (08518)<br /> (This is the general endowment for the Chancellor’s Scholars program.)</td> </tr></table><br /> $ __________ Hoppe Faculty Research Endowment (08310)<br /> <br /> $ __________ Kimmel Leadership Scholarship Endowment (08687)<br /> <br /> $ __________ Dr. Martin Luther King, Jr. Scholarship Endowment (08689)<br /> <br /> $ __________ International Student Scholarship Endowment (08280)<br /> <br /><table border="0" cellspacing="0" cellpadding="0"> <tr valign="top"> <td nowrap="nowrap">$ __________ </td> <td>S. Lavernn Wilson Scholarship Endowment (08113)<br /> (This endowment is used to help needy SIUE students cover their children’s daycare costs at the Early Childhood Center.)</td> </tr></table><br /> $ __________ Other, please specify: ___________________________________________<br /> <br /> <br /> <br /> Total Contributions: $ _________________<br /> <br /> <br /> <br /> Do you work for a matching gift company? (yes/no) : ______________________________<br /> (if 'yes' please list name of company)<br /> <br /> <br /> <br /><table border="0" cellspacing="0" cellpadding="0"> <tr> <td valign="top"> <table border="1" width="15" cellpadding="0" cellspacing="0"> <tr> <td> </td> </tr> </table> </td> <td nowrap="nowrap"> My check is enclosed, made payable to the SIUE Foundation</td> </tr> <tr> <td></td> <td nowrap="nowrap"></td> </tr> <tr> <td valign="top"> <table border="1" width="15" cellpadding="0" cellspacing="0"> <tr> <td> </td> </tr> </table> </td> <td nowrap="nowrap"> I wish to pay by credit card: ___ VISA ___ MasterCard ___ Discover ___ American Express <br /><br /> Card Number: _______________________________ Expiration Date: ______________<br /><br /><br /><br /> <br /> <strong>Signature:</strong> ______________________________________________________________</td> </tr></table><br /> <br /> <br /> The SIUE Foundation is a 501(c)(3) organization. Contributions are tax-deductible to the extent allowable by law.