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Make a Donation to UT Southwestern
 
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Welcome to our online donation page. Please follow the steps below to make a credit card contribution to UT Southwestern and help us accomplish our mission:

  • To improve health care in our community, Texas, our nation, and the world through innovation and education;
  • To educate the next generation of leaders in patient care, biomedical science and disease prevention;
  • To conduct high-impact, internationally recognized research;
  • To deliver patient care that brings UT Southwestern's scientific advances to the bedside — focusing on quality, safety, and exemplary patient service.

 

 
 
* Denotes Required Information
 
 
Donor Information
 
 
    Title:    
 
           
  * First Name:    
           
    Middle Name:    
           
  * Last Name:    
           
    Is this a Joint Donation? Yes    No    
 
    Joint Donor's Title:    
 
           
    Joint Donor's First Name:    
           
    Joint Donor's Middle Name:    
           
    Joint Donor's Last Name:    
 
    Relationship to Donor:    
 
    This Donation is made on behalf of a company:    
           
    Mailing Information of Donor    
 
           
  * Address:    
           
  * City:    
           
  * State:
           
  * Zip Code:    
           
  * Country:    
           
    Home Phone:    
           
    Office Phone:    
           
    Cell Phone:    
           
    Fax:    
           
  * E Mail:    
      Please keep me informed about the latest advances from UT Southwestern
           
           
    Donation Information    
           
           
  * Amount:



           
    Designation: Area of Greatest Need
Specific Use
       
    If for specific use or multiple designations, please specify:
      I prefer to make this donation anonymously.
           
           
    Payment Information    
           
  * Name as it Appears
on Credit Card:
   
           
  * Credit Card Type:    
           
  * Credit Card Number:
(Please do not use spaces or special characters)
   
           
  * Expiration Date: (mm/yyyy)    
           
  * Card Security Code:  Help
(Please click on the Help icon to find your Card Security Code)
   
         
    CHECK IF CREDIT CARD BILLING ADDRESS
IS SAME AS DONOR INFORMATION
      
       
    Billing Address (if different from Donor Information)  
       
  * Address:
       
  * City:
       
  * State:
       
  * Zip Code:
       
    In Honor or Memory of (Optional)
       
       
    Tribute Options:
       
    This gift is in recognition of:
       
    Please send notification of my gift to:
       
    Name:
       
    Address:
       
    City:
       
    State:
           
    Zip Code:    
           
    Relationship of the person notified to the honoree:    
           
       
           
    If you would like more than one individual notified of your gift, please call the UT Southwestern Development Office at 214-648-2344.    
           
    Matching    
           
  * Will your gift be matched by your employer?    
           
    Yes No      
           
    Employer Name:    
           
    Please mail your matching gift form to:

Office of Development
UT Southwestern Medical Center
5323 Harry Hines Boulevard
Dallas TX, 75390-9009
   
           
    Other Information    
           
  * What is your relationship to UT Southwestern?    
             
      I am:    
           
    If Other, please specify:    
           
     
   
           
    If you have questions or need help with this form please contact the UT Southwestern Development Office at 214-648-2344