Reflections Newsletter	Faces of Philanthropy

If you are a University employee and would like to support a fund through payroll deduction, please fill out this notification form to alert the Foundation Office of your intentions.

Name:
ID #:
USI Telephone:
College/Department:
Pay schedule:	MonthlyBiweekly
Pledge Total:
Begin Deductions:
For how many pay periods?:
Fund(s) you wish to support: (check as many as apply)
$	USI Annual Fund - where the need is greatest
$	Baccalaureate/Doctor of Medicine (B/MD) Scholarships
$	Friends of David L. Rice Library
$	The New Harmony Theatre
$	Historic New Harmony Society
$	Historic Southern Indiana
$	New Harmony Gallery of Contemporary Art
$	Scholarship (Please specify):
$	College of Business
$	College of Liberal Arts
$	College of Nursing & Health Professions
$	Pott College of Science, Engineering, and Education
$	Varsity Club
$	Society for Arts & Humanities
$	Other (Please specify):
$	Other (Please specify):
$	Other (Please specify):

What would you like to support? USI Annual Fund - where the need is the greatest Baccalaureate/Doctor of Medicine Scholarships Deans Scholarships Presidential Scholarships Bower-Suhrheinrich College of Education & Human Services Pott College of Science & Engineering College of Business College of Liberal Arts College of Nursing & Health Professions David L. Rice Library Historic New Harmony Historic Southern Indiana New Harmony Gallery of Contemporary Art The New Harmony Theatre USI Society for Arts & Humanities Varsity Club Give Now

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