Gift Commitment Form

GIFT COMMITMENT FORM

The Leithwood Award: the OISE Outstanding Thesis of the Year
The Outstanding Thesis of the Year Award was established by the Dean's Office to recognize exceptional, stimulating and cutting-edge research produced by doctoral students.

NAME ______PHONE ______FAX ______

TITLE ______E-MAIL______

ADDRESS ______

______

Donation levels:

$50____ $100_____$250_____$1000_____other $______

Donation Payment Options (please check one)

Option #1

□ Cheque enclosed (made payable to University of Toronto) in the amount of $ ______

□ Post-dated cheques enclosed in the amount of $______

Option #2

□ Credit Card payment in the amount of $ ______

□ VISA □ Mastercard □ AMEX Card #: ______/______/______/______Exp: ____/____

Name of Cardholder: ______Signature: ______

Please charge Monthly/Quarterly/Semi-Annually/Annually (please circle one)

Installment(s) of $ ______for a total of $ ______Beginning in ______(month), 20___and

Ending in ______(month), 20____

Option #3 (for University of Toronto faculty and staff)

□ Monthly Payroll Deduction:

I would like to make a monthly* gift of: $______

*I understand that I can change my monthly gift at any time via written notice. I am aware that my T4 slip acts as my tax receipt.

□ Please begin my monthly payroll on: _____/_____/_____ □ Please continue to make this deduction until Day Month Year notified otherwise

□ Please end my deduction on: _____/_____/_____ Personnel number:______

Day Month Year

Option #4

If you would like to create a gift of securities please contact Geoffrey Berry at 416-978-2214 or . If you would like someone to contact you regarding a gift of securities please check □ and return this form to the contact person below.

Please return this form along with your donation to:

OISE, Dean’s Office, 252 Bloor Street West, Toronto, Ontario M5S 1V6

Attention: Ina Hupponen, Associate Director, Development Telephone: 416-978-1126 email: Facsimile: 416-926-4723

All donations of $10 or more will receive a charitable tax receipt.

The University of Toronto respects your privacy. We do not rent, trade or sell our mailing lists.

BN charitable registration # 108162330 RR0001