Legacy Scholarship
Contribution Form
Yes, I want to support the Alumni Legacy Scholarship
at the University of Michigan-Dearborn!
Enclosed is my gift of _____$500
_____$250 _____$100 _____$50 Other
$________
My check is made payable to the University of Michigan-Dearborn.
Enclosed is my (or my spouse's) employer matching
gift form.
Charge my gift to: (circle one) VISA MC AmEx Discover (for gifts of $25 or more)
Account Number _____________________________________
Exp Date _____________
Signature _________________________________________________________________
The name(s) shown on my receipt of this gift should be:
___________________________________________________________________________
Year(s) of Graduation __________________ School/College
_________________________
Name ____________________________________________________________________
Address __________________________________________________________________
City, State, Zip _____________________________________________________________
Under Internal Revenue Service guidelines, the established
value of any benefits received in acknowledgment
of contributions to the Alumni Legacy Scholarship is
not substantial, therefore, the full amount of your gift is
a deductible contribution, to the extent the law provides.
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Return this completed with your contribution to:
The University of Michigan-Dearborn, Office of Alumni Relations,
4901 Evergreen Road, 1040 AB, Dearborn, MI 48128-1491.