Individual Donation Form

Donating on Behalf of

Personal Donation

To donate on behalf of a company/organization, please visit the company/organization donation form here.

To use forms of payment not listed below, please contact us at Engage@govst.edu or (708) 235-7510.
Your gift is tax deductible to the extent allowed by law.

Donor Information

Email Address*

Prefix

First Name*

Please include only one person's name. An additional name may be added at the end of this form under Gift Recognition.

Middle Name

Last Name*

Suffix

Birthdate*

Why we ask for your birthday: Your birthday helps us match your contributions to your donor profile irrespective of changes to your postal and email addresses.

Mailing Address*

Country

Street

City

Region

Postal Code

Phone Number

Donation Details

I am a Governors State University Employee

Please keep my gift anonymous

Payment Type*

Gift Amount*

There is a minimum $10 donation for online transactions.

*Gift Amount for payroll deduction is the amount per paycheck you want deducted.

*By selecting "Yes" below, I understand the amount indicated below will continue to be automatically deducted from each paycheck. If I desire to make any changes, I will notify the The GovState Foundation (engage@govst.edu) in writing.

Employee ID

GovState Email Address

Area of Impact

Category

Search Fund

Gift Funds (all)

Gift Funds (CPA)

Gift Funds (CAS)

Gift Funds (CBPA)

Gift Funds (COE)

Gift Funds (CHHS)

Gift Funds (EMP)

Gift Funds (GSUG)

Gift Funds (LHIS)

Gift Funds (LIBRY)

Gift Funds (NMSP)

Gift Funds (SXL)

You will receive and email confirmation regarding your request for payroll deduction.

Gift Recognition

I would like recognition for this gift applied to

Memo/Purpose

Additional Person

First Name

Last Name

Birthdate of Individual being recognized (optional)

Please notify the additional person of this gift:

Yes: Email the additional person

Yes: Mail the additional person

No

Email*

Address*

Country

Street

City

Region

Postal Code

In Honor Of

First Name

Last Name

Birthdate of Individual being recognized (optional)

Please notify the honoree of this gift:

Yes: Email the honoree

Yes: Mail the honoree

No

Email*

Address*

Country

Street

City

Region

Postal Code

In Memory Of

First Name

Last Name

Please notify another individual of this gift:

Yes: Email the other individual

Yes: Mail the other individual

No

Notification First Name

Notification Last Name

Email*

Address*

Country

Street

City

Region

Postal Code

Additional Company

Company/Organization Name

Company/Organization EIN

Please notify the company of this gift:

Yes: Email the company

Yes: Mail the company

No

Company Email*

Company Address*

Country

Street

City

Region

Postal Code

Increase Your Impact

Please contact me to discuss Planned Giving

I work for a matching gift company/organization

Company/Organization Name

Company/Organization Contact Details (Website, Email Address, or Phone Number)

Credit Card Information

Make this a recurring payment
Repeat payment
Recurring start date
Recurring stop date	End recurring payment afteryearsmonths
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