Thank you for your pledge to Central Connecticut State University
Complete the form below, verify all information and click the submit button. When your pledge is received, a pledge acknowledgement and a return envelope for your payment will be mailed to you.
The CCSU Foundation, Inc. is, for tax deduction purposes, a 501(c)(3) organization.
You may also print and mail or fax the printer friendly version (PDF) of the gift form.
Fields marked with an * are required. To make multiple selections hold the CTRL key down.
Name*
Affiliation(s)* Alumna/us Faculty Friend Parent Staff Student
Class* Select None 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Spouse Name
Affiliation(s) Alumna/us Faculty Friend Parent Staff Student
Class N/A 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
If parent, name of CCSU Student
Class N/A 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Home Address*
Home Address (continued)
City*
State*
Select Other Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Africa Armed Forces Americas Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific
Zip*
Country
Home Phone*
Home Email
Designate my pledge to*
Donor Giving Levels President's Club - $10,000+ in a ten year period Elihu Burritt Society - $1,000.00 - $9,999.99 David N. Camp Associates - $500.00 to $999.99 Emma Hart Willard Society - $250.00 – $499.99 Century Club - $100.00 to $249.99 Patron - $25.00 to $99.99 Donor - Up to $24.99
Amount(s)
My employer will match my gift
Company Name
Company Address
Company Address (continued)
Company City
Company State/Territory
N/A Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Africa Armed Forces Americas Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific
My spouse's employer will match my gift
Comments
Please click SUBMIT or RESET FORM once only.
Questions about giving or technical problems with this form, should be directed to:
Joseph Gordon, Jr. Associate Director of Development Central Connecticut State University Development Office 1615 Stanley Street New Britain, CT 06050 860-832-1740 Fax - 860-832-2585 gordonjo@ccsu.edu
1615 Stanley Street, New Britain, CT 06050 860.832.CCSU or toll free instate 1-888-733-2278
