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Thank you for your past and continuing financial contributions to HSAA for its mission to support the Department of Health Services, its students and its alumni. Because of your backing, we have been long-time Community Partners of the Department of Health Services in the UCLA School of Public Health, and sponsors of the Health Services Student Association (HSSA).

This year, the HSAA Board decided to defer the 2008 "Leaders of Today, Leaders of Tomorrow" dinner and focus our fundraising efforts on a mail campaign to support our student scholarship endowment and HSAA activities.

Full amounts are tax deductible. All donors will receive recognition in the HSAA Journal, HSAA website and 2009 "Leaders of Today, Leaders of Tomorrow" Dinner Program next year.



Required fields are indicated with an asterisk (*).
Your contribution is greatly appreciated!
*I would like to make:
  Other $
(Contributions of $1000 or more are eligible.)


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:

Matching Gift

  My/my spouse's employer will match my gift.
  Company name for matching gifts:
  This company is:
Payment method:
I am the parent of a current UCLA student
  Student name:
  Anticipated graduation year:
I am interested in learning more about how I can include UCLA in my estate plan.
This gift is anonymous.
 
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