Staff Giving Form

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					Details                                                                                                      Staff Giving Form
QUT Staff Number                                      Faculty/Division

    Dr    Miss      Ms      Mrs      Mr     Professor      Associate Professor
First Name                                            Middle                                             Surname

Home Address

Suburb                                                State                                              Postcode

Home Phone                                                                    Work Phone

Ways to Make a Gift
     Payroll deduction (Full-time and ongoing academic and professional staff only. Casual staff - please consider the following
     methods of giving).
     Effective with next pay period, deduct $_________ per pay period from your pre-tax salary (most tax effective).
	    Please	tick	here	if	applicable:
         I am a new payroll deduction donor.
         This replaces my present payroll deduction. (This authorisation shall remain in effect until you notify the Development Office that you wish to
         change or stop the payroll deduction).
     Cheque / Money order - I am enclosing a cheque/money order payable to QUT for $_________
     Credit Card - Please charge my credit card in the amount of $_________
         Visa     Mastercard        American Express

Card Number                                                                                              Expiry Date

Card Holder’s Name                                                                                       Date          /         /

Signature (Required for credit card or payroll deduction)

Areas to Make a Gift
Please choose the area(s) you would like to support and enter the portion of your gift that each should receive.
Please make sure the individual gift amounts equal your total gift.
	    University’s	Priorities	                                                                 Amount
     Learning Potential Fund (QUT will match the donations dollar for dollar)                 $ _________.
     Institute of Health and Biomedical Innovation (IHBI)                                     $ _________.
     Old Government House                                                                     $ _________.
     QUT Endowment (QUT will match the donations dollar for dollar)                           $ _________.
     QUT Libraries                                                                            $ _________.
     Alumni Development Fund                                                                  $ _________.
     Education (Remote practicum bursaries)                                                   $ _________.
     Law Founders Scholarship Endowment                                                       $ _________.
     Other area (please specify): ________________________                                    $ _________.

     I would like information about providing for QUT in my Will.
     I have already provided for QUT in my Will.

Please Return the Form Via
     Fax: 07 3138 1514
     OR Internal mail:
        QUT Staff Giving Program
        QUT Development Office
        Level 4, O Block Podium
        Gardens Point campus
     OR Call us on 07 3138 9097 to make a donation.
     OR Donate online: visit

Thank you for your support of QUT. Your gift will make a lasting impact
on the lives of our students and the quality of QUT’s program.

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Description: Staff Giving Form