Sign In




Required fields are indicated with an asterisk (*).
RSVP/Gift Information
*I would like to make:
  Other $

Contact Information   

Personal
Title:
* First name:
  Middle name:
* Last name:
  Suffix:
   I am making this gift as a proxy for my organization/company, which should be recognized as the legal donor
UCLA graduation year(s):

Spouse/Partner
  Name:  
  UCLA graduation year(s):

Joint Gift
* This is a joint gift with
my spouse/partner:

Contact Information
* Street:
 
U.S. Addresses  
*   City, State, Zip:
Non-U.S. Addresses  
  Non-U.S. City/County
  or Province/Postal Code:
  Country:
* This address is my:
* Home telephone:
Business telephone:

* E-mail address:
* This e-mail is my:

Gift Options
Matching Gift

  My/my spouse's employer will match my gift.
  Company name for matching gifts:
  This company is:
Tribute Gift
Please check this box if you would like to honor a family member, faculty member, business associate, community leader, or other with your contribution.
 
Payment
Payment method:
Additional Information
I am interested in learning more about creating a fellowship.
This gift is anonymous.
 
Comments: 

     



If you have any questions about this donation, please contact:

Heidi J. Saravia
Executive Director of Development
UCLA Health Sciences 
10889 Wilshire Boulevard, 12th Floor
Los Angeles, CA 90024
310-206-4565 office
310-968-9024 cell
HSaravia@mednet.ucla.edu
Find out about the security features of this web page that protect your account information.
If you do not wish to receive further fundraising information from UCLA Health Sciences, please either call us at (855) 364-6945 or email us at OptOutUCLAHSD@support.ucla.edu, providing your name, address, phone number and from which department you’re requesting to be removed.
Click here to view privacy policy and disclosure statements to prospective donors.
64269C/M-11392


© 2002-2024 UC Regents