· GiveCampus

Hope & Healing Crowdfunding Request

Thank you for your interest in creating a Hope & Healing fundraising page for University of Chicago Medicine and Biological Sciences. Please fill out this form and we will be in touch with you shortly.

* First Name

* Last Name

* Email

* Campaign or Project NameName of your campaign or project. This is what donors will see on top of the page.

By submitting information to create a project on this website, you acknowledge and confirm that you have permission directly from the individual to share any personal information you are providing. You also understand and agree that this information may be displayed publicly online as part of your project listing. Once information is displayed publicly on the internet, it may be copied and reshared by anyone outside of the University of Chicago Medicine health system and may be available indefinitely on public websites.

* Allocation of FundsWhere would you like gifts directed to?

* Is your fundraiser tied to an event

Event DateIf applicable

* Please submit what text you would like in your page's "About" section.This information will be visible on your fundraising page.

Is your fundraiser in honor or in memory of someone? If so, please enter their first and last name.

I have an image or video I would like to upload.Admin will request this asset in initial outreach if this box is checled.

* Would you like your goal displayed on your page?

What is your fundraising goal? Listed in either dollar amount of number of donors.While this is required to create a page, you can elect to hide this goal.

What inspired you to fundraise for The University of Chicago?This information will not be displayed on your page. This information is solely for admin to learn about your fundraising efforts.