Menu

USA Legacy Society Form
To be recognized in the Legacy Society, please let us know if you have included or are considering including a legacy gift to USA as part of your estate plan or in the form of another gift. Thank you for your commitment.
Questions that require an answer are marked with  *
   
1 * Title, First, Middle, and Last Name (please include your spouse if applicable):
   
   
2 * Mailing Address (Street, City, St, Zip):
   
   
3 * Phone Number:
   
   
4 * Email Address:
   
   
5 * Date of Birth:
   
   
6 Spouse Date of Birth:
   
   
7 USA College and Class Year (if alumnus/a):
   
   
8 Relationship to the University:
   
   
9 * I have remembered the University in the following (check all that apply):
   
   
10 I estimate the value of the gift to be:
   
   
11 My gift will be unrestricted for (please type YES next to your answer or specify the general area you would like to direct your gift for unrestricted use):
   
 General University - Where the Need is Greatest
 General USA Health - WHere the Need is Greatest
 College/School of
 General Athletics or Sport
 USA Health System Hospital/Clinic
 USA Libraries
 General Endowed Scholarship Fund
 Other
 I am unsure, please contact me (type YES if you would like us to contact you)
   
12 My gift will be restricted to support (please add details on a specific use or fund):
   
 Undergraduate Scholarship
 Graduate Fellowship
 Faculty Support Fund
 Research Fund
 Program Support
 Equipment
 Establish an endowment
 Athletics program/fund
 USA Health program/fund
 I am unsure, please contact me (type YES if you would like us to contact you)
   
13 Please provide any additional information on how you would best like your gift to be used:
   
   
14 * Please indicate your choice for Gift Recognition:
   
   
15 I would like to be recognized in the Legacy Society under the following name(s) (i.e. Mr. and Mrs. Joe Smith):
   
   
16 * Please type your first and last name below to indicate you approve the above Legacy Society Application. The Office of Development & Alumni Relations will be in touch with you to confirm your submission.
   
     

Contact Us: 

Please contact us if you have questions or need additional information about giving to USA. Thank you for your support.

Office of Development & Alumni Relations
650 Clinic Drive, TRP III, Ste. 1500
Mobile, AL 36688
Phone: (251) 460-7032
Fax: (251) 461-1776
development@southalabama.edu