Pause for Coz Scholarship Donation Form Date _____________ Donor Name ____________________________________ Class year(s) ________ Spouse Name ___________________________________ Class year(s) ________ Address ___________________________________________________________ Phone Number (w) _______________________ (h) ________________________ Email Address for Coz Updates _________________________________________ Gift Amount $ _________________ Thank You! Make payment

In full

Monthly with installments of $ _________ per month, beginning ___________

Annually over the next ______ years Donations by check or stock– see instructions below Donation by credit card

Credit card # ___________________________ Security Code _________ Expiration Date ___________ Visa, Mastercard, American Express, or Discover Corporate Matching Gift Option: Name of Company ____________________ (include form)

Make Checks Payable to: Santa Clara University (please do not put Coz Scholarship in the Payable line).

Please include the following on the memo line: “Coz Scholarship.”

Mailing Address – Mike Wallace Santa Clara University 500 El Camino Real Santa Clara, Ca 95053-1400

Additional gift questions or gifts of stock: Mike may be reached at 408-554-4981 or mjwallace@scu.edu.