College of Nursing and Health Sciences

College of Nursing and Health Sciences
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Gift Amount and Designation

I would like to make a gift of:
$ required
Designations required

If you selected other please list your designation:

Donor Information

First Name:
Last Name:
Maiden Last Name:
Primary UVM Affiliation
Please credit this gift jointly with my spouse:
Spouse/Partner Name:
Primary E-mail:
My Gift is a Tribute
Use this section to make a gift in someone's honor or memory.
Tribute Type:
Person's Full Name:

Please provide the information below if you would like us to notify someone of your tribute.  In cases where the family has expressed a preference, the UVM Foundation will honor the request of the family when sending acknowledgments for memorial gifts.

Notification Name:
Street, City, State, Country, Zip:
Employer Matching Gift
Employer Name
Does your employer have a matching gift program?
This gift qualifies for employer matching gift:

Please send your company's matching gift form to:

The UVM Foundation
Gift Records
411 Main St.
Burlington, VT 05401

Gift Instructions
Gift Instructions: