T H E H O U S I N G A N D F O O D S E RV I C E S E N D O W M E N T
CONTRIBUTION FORM
INFORMATION ABOUT YOU
Please Circle:
(Please print)
Dr./Ms.
Mrs./Mr.
Name___________________________________________________________ LAST
FIRST
MI
Home Address____________________________________________________ STREET
_______________________________________________________________ CITY
STATE
ZIP
Home Phone__________________________ Email______________________
PSU ID_________________________________________________________ Title____________________________________________________________ Campus_________________________________________________________ Unit/Business Address______________________________________________ _______________________________________________________________
GIVING OPTIONS
(Please choose one)
I am enclosing a check payable to “The Pennsylvania State University”
in the amount of: $______________________________________________
I would like to give through payroll deduction. (Please complete payroll
deduction section on reverse side).
Please charge my credit card in the amount of: $_______________________
Visa_
American Express
MasterCard
Discover
Account Number__________________________________________________
Expiration Date___________________________________________________
Name as it appears on credit card_____________________________________
Signature________________________________________________________
If you are contributing $2,500 or more: May we contact you about recognition
as a member of the Housing and Food Services Endowment Founders’ Club?
[ ] Yes. [ ] No, I prefer to keep my contribution anonymous.
I am pledging $2,500 or more and would like to spread out the payments.
I pledge to pay Penn State the sum of $_ ______________________________ *
payable in annual installments over __________ years (five-year maximum).
My first payment is enclosed. Please send me reminders in the month of
_______________________________________________________________ Signature________________________________________________________
Date____________________________________________________________ RETURN TO:AT UNIVERSITY PARK
Office of Annual Giving, 200 Bristol Avenue
University Park, PA 16802
AT OTHER LOCATIONS
Office of Director of Development or the Director of Institutional Advancement
PAYROLL DEDUCTION
Effective with the next pay period, deduct $_____________________________
per pay period (minimum is $5 per day period) specifically for the
Housing and Food Services Endowment.
I am paid:
Monthly
Biweekly
I am:
A new payroll deduction donor (of any gift to Penn State)
Changing the dollar mount of current deductions to include
the above contribution to the Housing and Food Services Endowment
Changing the allocation of current deductions to include a contribution
to the Housing and Food Services Endowment
*Explanation of Charges: If you are giving to more than one Penn State
area, please be sure the total allocation amounts equal your monthly gift.
Please use round dollar figures.
HFS Endowment
$
ALLOCATION
Amount per pay period
ALLOCATION
$
Allocation Code
XXXWH
Amount per pay period
$
Total amount per pay period
Employee signature (required for payroll deduction)
Date
This authorization shall remain in effect until I notify Annual Giving that I wish to
stop the payroll deduction.
Many employees find that by spreading out their gifts they
can do more than might be possible at one time.
Biweekly Payment
$5
$10
$15
$20
Annual Gift
$130
$260
$390
$520
Over 5 Years
$650
$1,300
$1,950
$2,600
Monthly Payment
$5
$10
$20
$25
$30
$35
$40
$45
Annual Gift
$60
$120
$240
$300
$360
$420
$480
$540
Over 5 Years
$300
$600
$1,200
$1,500
$1,800
$2,100
$2,400
$2,700
Housing and Food Services Endowment Founders’ Club: Become a founding
member of the Housing and Food Services Endowment by contributing $2,500
or more. Your gift can be spread out over five years. Founders will be recognized,
if they wish, by a special plaque in the Housing and Food Services Building.
Questions about the Housing and Food Services Endowment? Please contact
the Office of Human Resources, Auxiliary & Business Services, at 814-865-6388.
Details can also be found at www.hfs.psu.edu/recognition.
Giving to Penn State: Opportunities for giving are plentiful at all Penn State
locations. Visit www.giveto.psu.edu to learn more. Or, contact the Office of
Annual Giving at 814-863-2052.
AFAZFS XXXWH