Printable Form

You may submit your gift by completing this form and mailing it to the
address at the bottom of the form.

Donor Information:

Total Gift to Sam Houston State University is:

Gift Designation: Other:

Additional Information:

Title: First Name:

Middle Name/Initial:

Last Name: Suffix: Nickname:

Maiden Name: Gender: Male Female

Birth Date: Month: Day: Year:

SHSU Class Year:

SHSU Degree(s):

What is your connection to SHSU?

I am eligible for a matching gift program. My spouse is eligible for a matching gift program.

My matching gift company(s):
My Spouse's matching gift company(s):
(Matching gift forms can be obtained through your Human Resources Department.)

Is this a joint gift? Yes No

For publication purposes, my gift should be recognized as a gift from:

Spouse Title: Spouse First Name:

Spouse Middle Name/Initial:

Spouse Last Name: Spouse Suffix:

Spouse Nickname:

Spouse Maiden Name: Gender: Male Female

Spouse SHSU Class Year:

Spouse SHSU Degree(s):

Contact Information:

Street Address:

Mailing Address (if different):

City: State: Zip Code:

County: Country:

Phone: Cell Phone:

E-mail:

Business Information:

Org Name:

Position or Title:

Street Address:

Mailing Address (if different):

City: State: Zip Code:

County: Country:

Phone:

E-mail:

Fax:

Spouse Business Information:

Org Name:

Position or Title:

Street Address:

Mailing Address (if different):

City: State: Zip Code:

County: Country:

Phone:

E-mail:

Fax:

The SHSU Fiscal Year begins September 1 and ends August 31.

Payment Options

Checks or Money Orders:

Make payable to: Sam Houston State University

Credit Card: (minimum of $25.00)

Card Holder's Name:
Card Type: Card Number:
Exp Date: Month Year

Signature: _______________________________________________

Please print this page and mail with any checks or money orders (if applicable) to the following address:

Office of University Advancement
Sam Houston State University
Box 2537
Huntsville, Texas 77341-2537

University Advancement Home | Giving to SAM