Donation form

Thank you for choosing to give to uOttawa.

We sincerely thank you for helping us in our efforts to provide our students with exceptional learning opportunities, generate research breakthroughs, remain competitive globally and offer a unique bilingual educational and cultural environment.

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Donation Information
Amount:	$ 15 $ 15.00 $ 25 $ 25.00 $ 50 $ 50.00 $ 100 $ 100.00 $ 125 $ 125.00 $ 225 $ 225.00 $ 425 $ 425.00 $ 500 $ 500.00 $ 1,000 $ 1,000.00 $ 2,500 $ 2,500.00 $ 5,000 $ 5,000.00 Other ($5 min.) $     *
Designation:	Black Leaders in Medicine Scholarship
Additional Information
Type of gift	One-time gift Recurring gift
Frequency:	Weekly Monthly Quarterly Annually On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending:   Ending:
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Your relationship with uOttawa:	Alumnus / Student Employee / Professor /Retiree Other	*
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Title:	Docteur Docteure Dr. Madame Maître Monsieur Mr. Mrs. Ms. Professeur Professeure Professor
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Personal information contained on this form is collected under the authority of the 1965 University of Ottawa Act and in accordance with the Freedom of Information and Protection of Privacy Act. It will be used for purposes consistent with processing your donation, issuing a receipt for your donation, updating your personal information and providing you with information about alumni programs, events, activities, products and services provided by the University and affinity partners, news, fundraising campaigns, and donation and volunteering opportunities. If you have questions about the collection, use and disclosure of your personal information in this notice, contact the Alumni Relations Office at 613-562-5857 or 1-800-465-1888, or email alumni@uOttawa.ca.