PSU Foundation

To make a gift to Pittsburg State University, please fill out the form
below. When you are finished, press the "Submit Form" button at the
bottom of this form to send the information electronically.

NOTE: If you would prefer to make your gift via U.S. mail, you can do
one of the following:

Print this form, fill in the information and mail it to

Pittsburg State University Foundation, Inc.
P.O. Box 4005
Pittsburg, KS 66762
Call 620/235-4768 and request a gift pledge form.
Request a gift pledge form on-line by sending mail to
dev@pittstate.edu

Personal Information

Title
First:
Middle
Last:
Maiden:
Preferred Name:
SSN:
E-Mail Address:
Are you a PSU alumni?	Yes No
Graduation Year:

Spouse Information

Title
First:
Middle
Last:
Maiden:
Preferred Name:
SSN:
E-Mail Address:
Are you a PSU alumni?	Yes No
Graduation Year:

Address Information

Street:
City:
State/Province:
Zip/Postal Code:
Home Phone:
Work Phone:
Fax:
Is this a new address?	Yes No
Graduation Year:

Gift Clubs & Recognition Societies

Gifts designated to a PSU college, department or program qualifies
individuals for membership and benefits in one of the following gift
recognition clubs or societies at the following levels:

ANNUAL GIVING SOCIETY

Sarah Chandler Society	$1 - 99
Ralf Thomas Society	$100 - $499
R.S. Russ Society	$500 - $999
Crimson and Gold Society	$1,000 - $4,999
Presidents Society - Silver	$5,000 - $9,999
Presidents Society - Gold	$10,000 - $24,999
Presidents Society - Platinum	$25,000+
The Inner Circle	$5,000 unrestricted annually
Junior Presidents Society	Graduates of the last ten years who make a $1,000 annual gift receive the benefits of membership in the Presidents Society

LIFETIME GIVING SOCIETY

University Ambassador	$25,000 - $49,999
University Fellow	$50,000 - $99,999
University Patron	$100,000 - $249,999
University Benefactor	$250,000 - $499,999
University Founder	$500,000 - $999,999
Brandenburg Society	$1 million+
Heritage Society	Alumni and friends who have made provisions for Pittsburg State University in their estate plans.

*Individuals who assisted the University by securing a matching gift
from their employer receive recognition based upon the combined gift
total.

I would like my gift to be designated to one or more of the following
PSU areas (please indicate percentages):

	College of Arts and Science
	Kelce College of Business
	College of Education
	College of Technical Education
	Axe Library
	Men's Athletics
	Women's Athletics
	Scholarships
	Other (please specify)

I prefer to make a total pledge of $ over years.

Please send me a reminder annually semi-annually quarterly;

Does your employer have a matching gift program? Yes No

Employer Name:
Address:
Phone:

Send me information about how I might include Pittsburg State University in my estate plans.

For your records, I have already made a provision for Pittsburg State University in my will.