Your Name: 

Your 16 Digit UC ID Card Number:   

  I wish to donate the entire remaining balance in
my Bearcat Campus Card Account

  I wish to donate the amount specified to the
Senior Class Gift.  $

Post Graduation Address:

             City, State & Zip:

Phone Number:

Email Address:

By typing your name in the signature block below you are authorizing the
transaction specified to be acted upon and finalized.

Upon submitting, a copy of this request will be emailed to you for your donation record.