Foundation Information Form

And
The University of Colorado Foundation Inc.


Private philanthropy provides the School of Medicine at the University of Colorado Health Sciences with important funds for innovative education, research and patient care programs that might otherwise go unfunded. If you would like more information on how you can make a difference in health care by making a gift to the CU School of Medicine, please fill out the following and then click the submit button.

Name

First Name
Middle Name
Last Name

Address
Street and No.CityStateZip Code

Your E-mail Address

Home phone (Include Area Code)    

Business phone (Include Area Code)

Your Time Zone

Please Choose from the list.

Would you like us to call you? Yes No
If you indicate NO, your wishes will be respected.

If YES, what time is best to reach you?    
Please Choose from the list.

I am interested in giving a gift to support:

(specific disease, department, etc.)

Please check off your affiliation with the School of Medicine.
If "Other", please specify affiliation.

ClassYear Where Appropriate

Click the SUBMIT button to submit this information,


OR
The CLEAR button to erase and start over.

Thank Your For Your Interest
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