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Donate to Lakehead

About the Gift

I/We wish to support Lakehead University by making a gift of*:

$100
$250
$500
Other
Please specify how much you wish to donate $

My/Our gift is designated to*:

Scholarships
Orillia - Your Bright Future Campaign
Unrestricted (designated to the University's area of greatest need)
The Achievement Fund
Other

Please specify

I have special instructions for my gift:

Please provide instructions

Is this gift to be directed to an established scholarship, bursary,
award, or other named fund?:

Please indicate the Fund's name:

Is this to be made in Honour or Memory of someone?

Please indicate their name(s):

Please send an acknowledgement of my gift to:
Name:
Address:
City:
Province:
Postal Code:
Country:

Relationship to Lakehead University

Alumni
Friend
Parent

Student
Faculty/Staff
Retired

We will acknowledge receipt of your gift by mail. (* required fields)

Donations of $20 or greater will automatically be receipted.

First Name:
Last Name:
Address:
City:
Province:
Postal Code:
Country:
Home Phone:
Business Phone:
Email:

Is this a joint gift with your spouse?

Please indicate your spouse's information.

Did your spouse graduate from Lakehead University?

Your spouse's Name

First Name:
Last Name:

Recognition of your Gift

I wish my gift to be made anonymously
Please exempt my name from any donor listings

Please indicate how you would like your name(s) to appear in any donor listings.

Double the Impact of Your Gift

If you are a current employee, retired, or the spouse or widow(er) of an employee – or a member of the Board of Directors – one of the companies listed below might be waiting to match your gift to Lakehead University.

Key to Symbols:

Ratio - Company matches gifts at a ratio other than 1:1
d - Board of Directors are eligible to have gifts matched
r - retired employees are eligible to have gifts matched
s - spouses of employees are eligible to have gifts matched
$ - minimum donation amount

Additional Information (Optional)

I am interested in receiving information on planned gifts
I am interested in taking advantage of the tax incentives for gifts of securities.

Donor Rights
To view Donor Rights click here (Adobe PDF)

Lakehead University is a registered charity in Canada
Charitable Registration Number #11900 2681 RR0001

Thank you for your support!

The personal information provided on this form is collected pursuant to section 3 of the Lakehead University Act. Lakehead University respects the privacy of our donors and will use this personal information only to provide tax receipts, to contact you regarding your gift, and to keep you informed of other University and Alumni Association events and advancement activities. Any questions about the collection, use, and disclosure of this information should be directed to the Director of University Advancement, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario P7B 5E1, telephone: 807-343-8300,. You may ask at any time that we no longer use or disclose your personal information for a fundraising purpose.

University Advancement

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