Planned Giving and Bequest Information
Please tell us a little bit about yourself.

Affiliation with Dalhousie

Affiliation:*

Last Faculty Attended:

Degree:

Degree Year:

Personal Information

Salutation:*

First Name:*

Middle Name:

Last Name:*

Preferred Name:*

Date of Birth:

Banner ID: Example: B001234567

Email Address:*

Phone:

Area

Number

Ext.

Mailing Address

Unit/Apartment: Example: 305A

Address (line 1): Example: 22 Main St

Address (line 2): Example: PO Box 444

City:

Country:

Province/State:

Postal Code/Zip:

Please tell us which of the following best applies to you

I have already included Dalhousie University in my Will. I would like to receive Suggested Bequest Wording to leave a gift in my Will for Dalhousie. I would like information about establishing a scholarship/bursary to support future Dalhousie students.

Additional Comments

Please be sure to check the form to make certain your information is correct. You will receive an automatic notice to the email address you provided.

Privacy: The information provided on this online form will be used by Dalhousie University. Personal information contained in our records will be kept in confidence and will be used for Dalhousie-related business only.

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Planned Giving and Bequest Information

Affiliation with Dalhousie

Personal Information

Mailing Address

Please tell us which of the following best applies to you

Additional Comments

Office of Advancement