Become a College of Pharmacy Whitecoat Mentor
Pharmacy White Coat
Tell us who you are:
Required State:
Sponsor Options  - White Coats will be distributed at the August Professional Advancement Ceremony.
Please enter the code from the mailing or email you received (e.g. AG2013 ABC123 PML)      
I would like to be a White Coat Mentor this year to one or more students at $150 per student.
(Please indicate the number of students you would like to sponsor.)

I would like to make an additional annual gift of:
$150 $300 $450   or   $ per year for additional years:

Please charge my credit card annually using the information below  
Day and month I wish to be charged  
The first charge will be processed upon receipt of this form. Subsequent charges will be made annually on the day you indicate and will continue for the years indicated above.
Make an additional gift
Additional gift to the fund of your choice:
(Please include the fund number or name where this additional gift should be credited.)
Click here for a list of available funds
Total Amount: $
Please share my information with a current Pharmacy student.
I would like to be recognized as a White Coat Mentor, but please do not release my information.
Enter your credit card information:
Please enter the funds in US dollars.
We cannot guarantee that letters such as these (é, ú, â, ô, ñ, ö, ç,) will be processed correctly through the credit card processor. When typing, please do not use characters such as these. If you need assistance, please call our office at 419.530.7730.
Credit Card Type
    Visa MasterCard   American Express
Online Payments
Card Number
 C V V What is this?
Expiration Date /  
Billing information Same as above Not Same  
Billing First Name
Billing Last Name
Billing Address
Billing City
Billing State/Province

Billing Postal Code
Billing Country
Do you or your spouse work for a company that will match your gift?
Many employers sponsor matching gift programs that can double or triple your contribution to UT. If you are unsure if your company is a matching gift company or have questions about matching gift ratio, eligibility or procedure, click here.

Please note, your company's match counts toward your gift recognition level.

I will obtain a matching gift form from my employer and send it to the UT Foundation at 2801 W Bancroft St MS 319, Toledo, OH 43606
  Company Name
Company Address
If this gift will be matched by spouse's employer please indicate below:
  Spouse's Company Name
Spouse's Company Address
Submit this form

(Please do not submit the same page more than once.
Doing so could result in multiple charges to a credit card.)
For more information, contact Allie Berns, Assistant Director of Annual Giving, HSC
Phone: 419.530.5414 or email:

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