Donation Form Thank you for your thoughtful gift. Step 1 of 3 33% Thank you for your thoughtful gift.Donation Amount*$500$250$150$100$50Please direct my gift to support : Laurentian Priorities Fund Student Financial Assistance Voyageurs Athletics* Library Enhancements Research Student Refugee Program Specific Department Specific Award Mongolia Expedition* Women's History Week Fund* School of the Environment Student Financial Need* Centre for Research in Occupational Health and Safety* Men's Basketball Team* Student Food Bank* Master in Science Communication* Leaders of Tomorrow Fund in Celebration of Laurentian University's Model Parliament* Other * These designations will be matched for donations made on Giving TuesdayDepartment*Please specify the department you would like to direct your gift support to.Specific Award*Please specify the name of the award you would like to direct your gift support to. Learn more about Laurentian's Scholarships & Awards.Other*Please specify where you'd like to direct your gift supportResearch*Please specify where you'd like to direct your gift supportVoyageur Athletics*General Support of Voyageur AthleticsSpecific TeamPlease specify where you'd like to direct your gift supportPlease specify which team you would like to support*Frequency*Please consider a monthly gift. We will contact you directly to confirm method of payment for all recurring donations. I want to make a one-time donationI want to make a monthly recurring donation Donation Type*PersonalBusinessPersonal Information* First Last Business Information Title Company Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country TelephoneEmail Gift Options My employer is a Matching Gift Company. I wish to remain anonymous and do not want to appear in public donor listings. I would like more information on naming Laurentian University in my will. I have put Laurentian University in my will. Tax Receipt Eligibility I am eligible for a tax receipt The information on this form is collected under the authority of the Laurentian University Sudbury Act, 1960. It is related directly to and needed by the University for the purpose of fundraising and related activities. The information will be used and disclosed only for this purpose. If you have any questions about the collection, use and disclosure of this information, please contact the Director of Development, Laurentian University, 935 Ramsey Lake Road, Sudbury ON, P3E 2C6, 705-675-4872.