Online Giving at Western Illinois University

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Gift Agreement Form

(* Indicates that the field is required.)

Personal Information

First Name:

Middle:

Last: *

Spouse's/Partner's Name:

Middle:

Last:

Phone #:

() - *

E-mail: *

Address:

City:

*	State: * Zip: *	Country:
Check here if this is a new address

Business Information

Company Name:

Job Title:

Work Phone #:

() -

E-mail:

Work Address:

City:

State: Zip:

Country:

Gift Information

Gift Amount:

Designation:*

Academic Programs/Colleges
Scholarships
PAS, WIN, Library Atrium Society, WIUM, Marching Band Uniforms
Unrestricted (Area of Greatest Need)
Student Services
Leatherneck Club/Athletics Or, if designation is not listed, please specify below:

Comments:

Company Name:

My spouse's/partner's company will match my gift (additional information at bottom of this form)

Send your matching gift form to:

WIU Foundation
1 University Circle
Macomb, IL 61455
Fax: 309/298-1761
E-mail: WIUFoundation@wiu.edu

Matching Gifts

If you are affiliated with a company that matches contributions to higher education, your gift to Western may be matched, doubled, or — in some instances — more than doubled. Some companies also match gifts made by retirees and/or spouses.