There are two donation forms on this page.
Donating by check, credit card , etc. use Form "A"
Donating a hearing aid or other device use Form."B"

FORM "A"
Donation Form
Yes, I (we) want to partner with Callier to help maintain the excellent standards of all its educational, clinical and research programs.
mail to:
Callier Center for Communication Disorders
1966 Inwood Road
Dallas, TX 75235
Name_____________________________________________________________

Address____________________________________________________________

City_______________________State_________Zip__________

Phone(day)_________________________(evening)______________________
 

__  Enclosed is my (our) gift of $ _______________________________

I (we) would like my (our) gift to be used for:

___  Callier's most urgent needs
___  Rehab Therapy for Hearing Impaired Children and Adults
___  Cochlear Implant Program
___  Tinnitus (ringing in the ear) Program
___ Callier Preschool Scholarships Funds
___  Early Childhood Deaf Education Program
___  Parent Training Program
___  Cochlear Implant Summer Listening Camp
 

___  Other_________________________________________________

___  I would like my gift to tribute acknowledgment to:   ___  honor of   __memory of
Name___________________________
Address_________________________
City/State/Zip______________________
 
 
 
 

FORM "B"

Donation Form
www.callier.utdallas.edu/donation/donor.html

(print and mail in with your gift)
mail to:
Callier Center for Communication Disorders
1966 Inwood Road
Dallas, TX 75235

Date __________

Name___________________________________________ 

Address_________________________________________

_______________________________________________

Phone__________________________

I wish to donate _________________________________________________

____________________________________________________________

___________________________________________________________

to the UTD/Callier Center for Communication Disorders. Please send an acknowledgement of this donation so that I may file it with my IRS Income Tax Return as a charitable donation. 
Please send the University's letter of charitable donation to the above address shown.
 

Signature _____________________________________________________________

This form is not the legal document to be filed with your income tax return this is a statement of donated items. Legal documentation will be send to your address from the Univerisity of Texas at Dallas.