Note: The GSSM Foundation has been advised by our service provider that this donation form has been reviewed and found to be unaffected by the Heartbleed vulnerability. It is safe for encrypted transactions.

Donation Information
Amount:	$100.00 $50.00 $25.00 Other $     *
Designation:	Innovation Fund (where the school needs it most) Residential Financial Aid Summer Program for Research Interns Other
Other	*
Additional Information
Type of gift:	One-time gift Recurring gift Installments
Frequency:	Weekly Monthly Quarterly Annually On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending:   Ending:
Corporate:	This donation is on behalf of a company
Anonymous:	I prefer to make this donation anonymously
Comments:
Relationship to GSSM:	<Please Select> Alumnus Alumnus Parent Current Parent Friend Business	*
Preferred name (for recognition):
Billing Information
Title:	Dr. Miss Mr. Mrs. Ms. Rev. The Honorable
First name:		*
Last name:		*
Country:	United States United Kingdom Australia France Japan Colombia
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State:	<Please Select> AA AE AL AK AB AS AP AZ AR BC CA CZ CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MB MH MD MA MI MN MS MO MT NE NV NB NH NJ NM NY NL NC ND MP NT NS NU OH OK ON OR PW PA PE PR QC RI SK SC SD TN TX UT VT VI VA WA WV WI WY YT OoC	*
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Payment Information
Cardholder's Name:		*
Credit Card Number:		*
Card Type:	American Express Discover Maestro MasterCard Visa	*
Valid From:	01 02 03 04 05 06 07 08 09 10 11 12  / 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014  (Maestro/Switch/Solo only)
Card Expiration:	01 02 03 04 05 06 07 08 09 10 11 12  / 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028	*
Issue Number:	(Maestro/Switch/Solo only)
Card Security Code:		*
	Note: The Card Security Code is not required for Maestro, Switch and Solo cards.
Matching Gifts
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Company:		*