THE UCLA FOUNDATION: FWC SCHOLARSHIP FUND #9017

Name of Donor_________________________________________________________________________________

¨ This is a joint gift. Spouse or Partner name_______________________________________________________

Address: ¨Home ¨ Work ______________________________________________________________________

City__________________________________State_______Zip_____________Telephone_____________________

This gift is ¨ in memory of ¨ or a tribute to_____________________________for________________________

Please send acknowledgment to__________________________________________________________________

Address________________________________City________________________State_________Zip___________

Please indicate amount below.

$25_____$50_____$100_____$150_____$200_____$250_____$300_____$400_____$500____Other$_______

¨ Enclosed is my check payable to The UCLA Foundation.

¨ I prefer to pay with my credit card. Visa _____ MasterCard _____ Am. Express ______ Discover______

Name on card (Please print.)_______________________________________ Expiration date_______________

Credit Card number____________________________________________ Amount to be charged____________

If you are interested in establishing a named scholarship or making a bequest to the FWC Scholarship Fund in your will, contact Helen Nefkens, FWC Scholarship Chair, tel.# 818-986-7007, e-mail hnefkens@yahoo.com. For questions about donations, contact Executive Director of Individual Giving at The UCLA Foundation Steve Gamer at 310-794-2305 or sgamer@support.ucla.edu.

Fund 9017 Appeal Code AR174

Privacy Notice: The 1977 California Information Practices Act requires UCLA to inform individuals asked to supply information about themselves of the following: UCLA is requesting this information to update the general resource files of its External Affairs Department. Furnishing the information is strictly voluntary and will be maintained confidential. The information may be used by other University departments in the regular course of business but will not be disseminated to others except as required by law. You have the right to review your own data file. Inquiries should be forwarded to Assistant Vice Chancellor-Finance and Information Management, External Affairs, 10920 Wilshire Blvd. 9^th Floor, Los Angeles, CA 90024-6511. Donor’s Consent to use Personal Information: The University is grateful for the support it receives from Alumni, parents and friends. One of the ways we express our thanks is by listing the names of donors in Web-based and/or print publications. Should you wish that your name not appear as a donor, please notify us if you have not already done so. The Fiduciary Responsibility of The UCLA Foundation: The UCLA Foundation is a California non-profit corporation organized for the purpose of encouraging voluntary private gifts, trusts, and bequests for the benefit of the UCLA Campus. Responsibility for governance of the Foundation, including investments, is vested in the Board of Directors. Recovery of Operating Costs from Private Gifts: As is customary with universities and other non-profit organizations across the country, a one-time gift fee is applied to all gifts to provide essential support to UCLA’s overall operation. The fee is currently 5%. Endowed Funds: The Chancellor may, from time to time, authorize The UCLA Foundation to return all or a portion of the fund’s spendable income to fund principal in order to protect the real value of fund principal, or if spendable income substantially exceeds real current need, or if other compelling circumstances warrant the addition of spendable income to fund principal. In the event the fund does not reach the endowment minimum; or the program ceases to exist at UCLA, the campus school or department will utilize the proceeds from the fund in an area and manner as closely related as possible to the original intent and purposes for which the fund was established. Fundraising Permit: In compliance with the Charitable Solicitation Ordinance in the City of Los Angeles (L.A. Municipal Code Article 4, Section 44), a fundraising permit must be obtained when soliciting contributions using outside mailing lists. Effective date 9/6/05