Name:________________________________

$______College of Allied Health Sciences

Address:______________________________

$______College of Arts and Sciences

_____________________________________

$______College of Business

$______College of Education and Human Services

Social Security Number:__________________

$______College of Optometry

College:_______________________________

$______College of Pharmacy

Department:____________________________

$______College of Technology

$______Univ. College/Honors Program

$______Library

My total contribution is:

$______Bulldog Club – Athletics

$______Student Activities

_____$25  _____$50  _____$100  _____$250  _____$500  $_________

$______Student Scholarships

$______Alumni Association

Payable by cash/check/credit card and/or by payroll deduction.

$______Fund for Excellence (supporting a range of educational activities, the flexibility of this Fund makes it especially helpful).

PAYROLL DEDUCTION AUTHORIZATION

CREDIT CARD AUTHORIZATION

I authorize the Ferris Payroll Department to deduct in equal installments each pay period that amount required to reach the total gift listed above beginning ______200__ through ______200__.

I wish to donate by:

_____MasterCard  _____Visa  _____Discover

Name of card holder: ___________________

Card number: _________________________

Signature: ___________________________

Signature: ____________________________

Date: _______________________________

Expiration date: _______________________