First Name   Middle Initial  
Last Name
Maiden Name (if applicable)


Spouse First Name   Spouse Last Name

My spouse is a BCU Alumni  Yes   No 


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City   State   Zip 
Home Phone   Cell Phone
Email Address    Class Year


What is your relationship to BCU? 

Is this a payment on your pledge? Yes  No 

Please use my gift for:   If other, please specify

In memory of

My gift today was prompted by  

If other, please specify


Card Type
Name (as it appears on card)
Gift Amount       Credit Card Number
Expiration Date Security Code (VRU Number)


To formally recognize and thank you for your support, your name will be included in the Honor Roll of Donors.

Please treat my gift as anonymous and do not list my name in the Honor Roll of Donors publication.

Please provide me with more information on the following
Estate & Planned Gifts
Outright Contributions

I have included Briar Cliff University in my estate plan.