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Donation Form

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Please fill out and print this form

Alumni Association, School of Graduate Studies (AASGS)

SUNY Downstate Medical Center

STUDENTS FELLOWSHIP FUND DONATION FORM

Please complete the form, print it and mail it with your donation to the address provided.

YES I would like to help the School of Graduate Studies continue to attract talented students. I have enclosed my check for the following amount:

                         $5,000   

                         $2,500   
           
                         $1,250   
           
                         $500   

                         $250

                         $125   

                         Other $    

This donation is in honor of:

Name  

Company

Representative Title

Address
                                 
City/State/Zip                    

Phone  

E-mail

Your donation is tax-deductible. Make your check payable to: HSCB Foundation.
In the memo section write: AASGS Students Fellowship Fund.

Please mail a printout of this completed form along with your donation in the enclosed
self-addressed envelope to:            
Ina Lancman
            Director, SGS Alumni Relations & Development
            SUNY Downstate Medical Center
            450 Clarkson Avenue, Box 94
            Brooklyn NY  11203

For further information, please call (718) 270-4404
or e-mail  ina.lancman@downstate.edu

Your gift is important.

To continue to act as a magnet for young talent, the School of Graduate Studies needs your help.
The School provides a competitive academic environment for its students; with your help, it will provide competitive financial support as well.

Thank you for your support.