2025 UTMB SECC Galveston Region One Time Donation

2025 Galveston Region SECC One-Time Donation Form

You can select/designate up to 6 charities with this form.
Thanks for your support of UTMB’s State Employee Charitable Campaign. In partnership with our local campaign manager, United Way, we now offer this new online giving option. Required fields are marked by an “*”; you may select up to six charities to support with your gift. A $1 fee helps offset the processing costs. Visit www.utmb.edu/secc to learn more.
Name*

First NameLast Name
Email*
example@example.com
Mobile Phone Number*
Please enter a valid phone number.
Mailing Address (for donation acknowledgement)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tell us which information we can share with the agency (or agencies) you designated to receive your gift.*

NameGift AmountEmail Address (for donation acknowledgement)Mailing Address (for donation acknowledgement)Record my gift as anonymous
Please designate/select the FIRST ORGANIZATION that will receive your one-time donation.*
Charities are sorted by area (i.e. Galveston, Houston, Capital Area, etc.)
How much do you want to donate to the FIRST ORGANIZATION that you selected?*
This field can only contain numeric values - don't include the $ sign.
Please designate/select the SECOND ORGANIZATION that will receive your one-time donation.
Charities are sorted by area (i.e. Galveston, Houston, Capital Area, etc.)
How much do you want to donate to the SECOND ORGANIZATION that you selected?
This field can only contain numeric values - don't include the $ sign.
Please designate/select the THIRD ORGANIZATION that will receive your one-time donation.
Charities are sorted by area (i.e. Galveston, Houston, Capital Area, etc.)
How much do you want to donate to the THIRD ORGANIZATION that you selected?
This field can only contain numeric values - don't include the $ sign.
Please designate/select the FOURTH ORGANIZATION that will receive your one-time donation.
Charities are sorted by area (i.e. Galveston, Houston, Capital Area, etc.)
How much do you want to donate to the FOURTH ORGANIZATION that you selected?
This field can only contain numeric values - don't include the $ sign.
Please designate/select the FIFTH ORGANIZATION that will receive your one-time donation.
Charities are sorted by area (i.e. Galveston, Houston, Capital Area, etc.)
How much do you want to donate to the FIFTH ORGANIZATION that you selected?
This field can only contain numeric values - don't include the $ sign.
Please designate/select the SIXTH ORGANIZATION that will receive your one-time donation.
Charities are sorted by area (i.e. Galveston, Houston, Capital Area, etc.)
How much do you want to donate to the SIXTH ORGANIZATION that you selected?
This field can only contain numeric values - don't include the $ sign.
Please confirm your total donation amount (includes $1.00 online transaction fee)

Total Donation IMPORTANT: Please make sure that your Total Donation Amount equals and matches the total of the amounts you have designated to each agency). *

USDDescription

Credit or Debit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Signature

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2025 Galveston Region SECC One-Time Donation Form