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class="olg-section__label" for="otherAmount_1"> Other Amount </label> <input id="otherAmount_1" inputmode="decimal" class="form-control olg__textfield olg__textfield--number other-amt js-gift-other-amt" maxlength="9" data-target=".js-oth" value="" /> </div> </div> <input type="text" value="25.0" autocomplete="off" name="donation-amt-1" id="donation-amt-1" class="donationAmt form-control mostly-hidden" tabindex="-1" data-field-merchant="" data-validation="validateGiftAmt" /> <div class="invalid-feedback row"> <i class='fa fa-exclamation-circle'></i><span class="js-invalid-feedback-msg js-gift-amt-msg"/> </div> </div> </fieldset> </div> </div> <div> <div class="tab-content js-input-descriptions form-group col-xs-12" id="button-descriptions"> <div data-parent=".js-input-descriptions" class="collapse show js_51710191" id="gift1desc_51710191" aria-labelledby="gift1btn_51710191"></div> <div data-parent=".js-input-descriptions" class="collapse js_51710192" id="gift1desc_51710192" aria-labelledby="gift1btn_51710192"></div> <div data-parent=".js-input-descriptions" class="collapse js_51710193" id="gift1desc_51710193" aria-labelledby="gift1btn_51710193"></div> <div data-parent=".js-input-descriptions" class="collapse js_51710194" id="gift1desc_51710194" aria-labelledby="gift1btn_51710194"></div> <div data-parent=".js-input-descriptions" class="collapse js_51710195" id="gift1desc_51710195" aria-labelledby="gift1btn_51710195"></div> <div class="tab-pane js-oth collapse" style="display: block;"></div> </div> </div> <input type='hidden' id="school_1" name="school_1" class='form-control js-school' data-field-merchant='' value="UNV" data-levelName="University"/> <div class="row"> <div class="form-group col-xs-12 col-md-8 olg-gift__school-fund"> <label for="fund_1" class="olg-section__label" > Select a Fund <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <select class='form-control init-select2 js-fund' id="fund_1" name="fund_1" style="width:100%" data-field-merchant="merchant" data-field-val="170-305073RG0001" data-validation="validateFund" required="required"> <option value="" disabled="disabled">Select a Fund</option> <option value="170-305073RG0001" selected="selected" >Director's Discretionary Fund</option> <option value="170-305088RG" >Counseling and Mental Health Services Discretionary Fund</option> </select> <div class="invalid-feedback fund1-invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Fund is required</span> </div> </div> </div> </div> </div> </div> <input type="hidden" data-field-merchant="" name="maxGiftNumber" id="maxGiftNumber" value="1"/> </div> <div class="row your-gift-pledge--content collapse" id="giftComment"> <div class="col"> <div> <div class="form-group"> <label for="giftDetails" class="olg-section__label"> Other Fund Name <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <textarea name="giftDetails" id="giftDetails" autocomplete="off" maxlength="600" class="form-control olg__textfield" data-field-merchant="merchant"></textarea> <div class="invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Other Fund Name is required</span> </div> </div> </div> </div> </div> <hr class="gift-separator gift-separator--last" /> <input type="hidden" id="jointIndicator" name="jointIndicator" data-field-merchant='' value="closed"/> <input type="hidden" id="honorIndicator" name="honorIndicator" data-field-merchant='' value="closed"/> <input type="hidden" id="pledgeIndicator" name="pledgeIndicator" data-field-merchant='' value="closed"/> <input type="hidden" id="pmtEmplMatchIndicator" name="pmtEmplMatchIndicator" data-field-merchant='' value="closed"/> </section> <div> </div> <section class="olg-section" id="contact-section"> <div> <h2 class="olg-section__heading"><span>Your Contact Information</span></h2> <div class="row"> <div class="col-xs-12 col-md-6"> <div> <div class="form-group"> <label for="contactTitle" class="olg-section__label"> Title </label> <select autocomplete="honorific-prefix" id="contactTitle" name="contactTitle" class="form-control olg__textselect" data-field-merchant="merchant"> <option value="">None Selected</option> <option value="MISS">Miss</option> <option value="MR">Mr.</option> <option value="MRS">Mrs.</option> <option value="MS">Ms.</option> <option value="DEAN">Dean</option> <option value="DR">Dr.</option> <option value="FATHER">Father</option> <option value="GEN">Gen.</option> <option value="HON JUSTICE">Hon. Justice</option> <option value="IMAM">Imam</option> <option value="JUDGE">Judge</option> <option value="JUSTICE">Justice</option> <option value="KING">King</option> <option value="LADY">Lady</option> <option value="LT">Lt.</option> <option value="LT (JG)">Lt. (JG)</option> <option value="LT CDR">Lt. Cdr.</option> <option value="LT COL">Lt. Col.</option> <option value="LT GEN">Lt. Gen.</option> <option value="LT GOV">Lt. Gov.</option> <option value="MAESTRO">Maestro</option> <option value="MAJOR">Maj.</option> <option value="MAJ GEN">Maj. Gen.</option> <option value="MONSIGNOR">Monsignor</option> <option value="MOST REV">Most Rev.</option> <option value="MOTHER">Mother</option> <option value="PRINCE">Prince</option> <option value="PRINCESS">Princess</option> <option value="PROF">Prof.</option> <option value="RABBI">Rabbi</option> <option value="REAR ADM">Rear Adm.</option> <option value="REV">Rev.</option> <option value="REV CANON">Rev. Canon</option> <option value="REV DR">Rev. Dr.</option> <option value="REV MR">Rev. Mr.</option> <option value="REV MRS">Rev. Mrs.</option> <option value="RT HON">Rt. Hon.</option> <option value="RT HON LORD">Rt. Hon. Lord</option> <option value="RT REV">Rt. Rev.</option> <option value="RT REV DR">Rt. Rev. Dr.</option> <option value="S SGT">S. Sgt.</option> <option value="SENATOR">Sen.</option> <option value="SGT">Sgt.</option> <option value="SIR">Sir</option> <option value="SISTER">Sister</option> <option value="THE HON">The Honorable</option> <option value="THE HON JUSTICE">The Honorable Justice</option> <option value="THE MOST HON">The Most Honorable</option> <option value="THE MOST REV">The Most Reverend</option> <option value="THE REV">The Reverend</option> <option value="THE REV CANON">The Reverend Canon</option> <option value="THE REV DR">The Reverend Doctor</option> <option value="THE REV MR">The Reverend Mister</option> <option value="THE RT HON">The Right Honorable</option> <option value="THE RT REV">The Right Reverend</option> <option value="THE RT REV DR">The Right Reverend Doctor</option> <option value="THE VENERABLE">The Venerable</option> <option value="VERY REV">Very Rev.</option> <option value="VICE ADM">Vice Adm.</option> <option value="VISCOUNT">Viscount</option> <option value="VISCOUNTESS">Viscountess</option> </select> </div> </div> </div> </div> <div class="row"> <div class="col-xs-12 col-md-6"> <div> <div class="form-group"> <label for="ship_to_forename" class="olg-section__label"> First Name <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <input type="text" name="ship_to_forename" id="ship_to_forename" value="" autocomplete="given-name" maxlength="60" class="form-control olg__textfield" data-copytarget="bill_to_forename" data-field-signed="signed" data-caption="First Name" required="required"/> <div class="invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Contact First Name is required</span> </div> <input type="text" aria-hidden="true" class="copy-target" id="bill_to_forename" name="bill_to_forename" value="" autocomplete="off" placeholder="bill_to_forename" data-field-signed="signed"/> </div> </div> </div> </div> <div class="row"> <div class="col-xs-12 col-md-6"> <div> <div class="form-group"> <label for="contactMiddleName" class="olg-section__label"> Middle Name </label> <input type="text" name="contactMiddleName" id="contactMiddleName" value="" autocomplete="additional-name" maxlength="25" class="form-control olg__textfield" data-field-merchant="merchant" data-caption="Middle Name"/> </div> </div> </div> </div> <div class="row"> <div class="col-xs-12 col-md-6"> <div> <div class="form-group"> <label for="ship_to_surname" class="olg-section__label"> Last Name <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <input type="text" name="ship_to_surname" id="ship_to_surname" value="" autocomplete="family-name" maxlength="60" class="form-control olg__textfield" data-copytarget="bill_to_surname" data-field-signed="signed" data-caption="Last Name" required="required"/> <div class="invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Contact Last Name is required</span> </div> <input type="text" aria-hidden="true" class="copy-target" id="bill_to_surname" name="bill_to_surname" value="" autocomplete="off" placeholder="bill_to_surname" data-field-signed="signed"/> </div> </div> </div> </div> <div class="row"> <div class="col-xs-12 col-md-6"> <div> <div class="form-group"> <label for="contactSuffix" class="olg-section__label"> Suffix </label> <select autocomplete="honorific-suffix" id="contactSuffix" name="contactSuffix" class="form-control olg__textselect" data-field-merchant="merchant"> <option value="">None Selected</option> <option value="Jr.">Jr.</option> <option value="Sr.">Sr.</option> <option value="II">II</option> <option value="III">III</option> <option value="IV">IV</option> <option value="IX">IX</option> <option value="V">V</option> <option value="VI">VI</option> <option value="VII">VII</option> <option value="VIII">VIII</option> </select> </div> </div> </div> </div> <div class="row"> <div class="col-xs-12 col-md-3"> <div> <div class="form-group"> <label for="contactClassYear" class="olg-section__label"> Class Year </label> <input type="text" pattern="\d\d(\d\d)?" name="contactClassYear" id="contactClassYear" value="" autocomplete="off" maxlength="4" class="form-control olg__textfield" data-field-merchant="merchant" data-caption="Class Year"/> <div class="invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Invalid Class Year</span> </div> </div> </div> </div> <div class="col-xs-12 col-md-6"> <div> <div class="form-group"> <label for="contactSchool" class="olg-section__label" > School </label> <select class='form-control init-select2' id="contactSchool" name="contactSchool" style="width: 100%" data-field-merchant="merchant"> <option value=""></option> <option value="ART" >American Repertory Theatre</option> <option value="FAS" >Faculty of Arts and Sciences</option> <option value="GSD" >Graduate School of Design</option> <option value="GSE" >Graduate School of Education</option> <option value="HBS" >Harvard Business School</option> <option value="COL" >Harvard College</option> <option value="HDS" >Harvard Divinity School</option> <option value="EXT" >Harvard Extension School </option> <option value="GSA" >Harvard Griffin Graduate School of Arts and Sciences</option> <option value="KSG" >Harvard Kennedy School</option> <option value="HLS" >Harvard Law School</option> <option value="HMS" >Harvard Medical School</option> <option value="SDM" >Harvard School of Dental Medicine</option> <option value="SPH" >Harvard T.H. Chan School of Public Health</option> <option value="DAS" >Harvard's Paulson School of Engineering and Applied Sciences</option> <option value="NIE" >Nieman Foundation</option> <option value="RAD" >Radcliffe College</option> <option value="RDI" >Radcliffe Institute</option> <option value="UFI" >University Interfaculty Initiatives</option> </select> </div> </div> </div> </div> <div class="row"> <div class="col-xs-12 col-md-6"> <div> <div class="form-group"> <label for="contactCountry" class="olg-section__label" > Country </label> <select autocomplete="off" class='form-control init-select2' id="contactCountry" name="ship_to_address_country" style="width: 100%" data-copytarget="bill_to_address_country" data-field-signed="signed" data-field-val="US"> <option value="" disabled="disabled"></option> <option value="AF" >Afghanistan</option> <option value="AL" >Albania</option> <option value="DZ" >Algeria</option> <option value="AD" >Andorra</option> <option value="AO" >Angola</option> <option value="AI" >Anguilla</option> <option value="AG" >Antigua and Barbuda</option> <option value="AR" >Argentina</option> <option value="AW" >Aruba</option> <option value="AU" >Australia</option> <option value="AT" >Austria</option> <option value="BS" >Bahamas</option> <option value="BH" >Bahrain</option> <option value="BD" >Bangladesh</option> <option value="BB" >Barbados</option> <option value="BE" >Belgium</option> <option value="BZ" >Belize</option> <option value="BM" >Bermuda</option> <option value="BT" >Bhutan</option> <option value="BO" >Bolivia</option> <option value="BA" >Bosnia and Herzegovina</option> <option value="BW" >Botswana</option> <option value="BR" >Brazil</option> <option value="GB" >British Citizenship</option> <option value="SB" >British Solomon Islands</option> <option value="VG" >British Virgin Islands</option> <option value="BN" >Brunei Darussalam</option> <option value="BG" >Bulgaria</option> <option value="BF" >Burkina Faso</option> <option value="BI" >Burundi</option> <option value="KH" >Cambodia</option> <option value="CM" >Cameroon</option> <option value="CA" >Canada</option> <option value="CV" >Cape Verde Islands</option> <option value="KY" >Cayman Islands</option> <option value="CF" >Central African Republic</option> <option value="TD" >Chad</option> <option value="GB" >Channel Islands</option> <option value="CL" >Chile</option> <option value="CO" >Colombia</option> <option value="KM" >Comoro Islands</option> <option value="CK" >Cook Islands</option> <option value="CR" >Costa Rica</option> <option value="CI" >Cote D'ivoire</option> <option value="HR" >Croatia </option> <option value="CU" >Cuba</option> <option value="CY" >Cyprus</option> <option value="CZ" >Czech Republic</option> <option value="KP" >Democratic People's Republic of Korea</option> <option value="CD" >Democratic Republic of the Congo</option> <option value="DK" >Denmark</option> <option value="DM" >Dominica</option> <option value="DO" >Dominican Republic</option> <option value="TL" >East Timor</option> <option value="EC" >Ecuador</option> <option value="EG" >Egypt</option> <option value="SV" >El Salvador</option> <option value="GB" >England</option> <option value="GQ" >Equatorial Guinea</option> <option value="ER" >Eritrea</option> <option value="EE" >Estonia</option> <option value="ET" >Ethiopia</option> <option value="FK" >Falkland Islands</option> <option value="FO" >Faroe Islands</option> <option value="FJ" >Fiji</option> <option value="FI" >Finland</option> <option value="" >Foreign Phone Only</option> <option value="FR" >France</option> <option value="GF" >French Guiana</option> <option value="PF" >French Polynesia</option> <option value="GA" >Gabon</option> <option value="GE" >Georgia</option> <option value="DE" >Germany</option> <option value="GH" >Ghana</option> <option value="GI" >Gibraltar</option> <option value="GR" >Greece</option> <option value="GL" >Greenland</option> <option value="GD" >Grenada</option> <option value="GP" >Guadeloupe</option> <option value="GT" >Guatemala</option> <option value="GN" >Guinea</option> <option value="GW" >Guinea-Bissau</option> <option value="GY" >Guyana</option> <option value="HT" >Haiti</option> <option value="VA" >Holy See (Vatican City State)</option> <option value="HN" >Honduras</option> <option value="HK" >Hong Kong</option> <option value="HU" >Hungary</option> <option value="IS" >Iceland</option> <option value="WS" >Independent State of Samoa</option> <option value="IN" >India</option> <option value="ID" >Indonesia</option> <option value="IR" >Iran </option> <option value="IQ" >Iraq</option> <option value="IE" >Ireland</option> <option value="IM" >Isle of Man</option> <option value="IL" >Israel</option> <option value="IT" >Italy</option> <option value="JM" >Jamaica</option> <option value="JP" >Japan</option> <option value="JO" >Jordan</option> <option value="KE" >Kenya</option> <option value="KI" >Kiribati</option> <option value="XK" >Kosovo</option> <option value="KW" >Kuwait</option> <option value="KG" >Kyrgyzstan</option> <option value="LA" >Laos</option> <option value="LV" >Latvia</option> <option value="LB" >Lebanon</option> <option value="LS" >Lesotho</option> <option value="LR" >Liberia</option> <option value="LY" >Libya</option> <option value="LI" >Liechtenstein</option> <option value="LT" >Lithuania</option> <option value="LU" >Luxembourg</option> <option value="MO" >Macau</option> <option value="MK" >Macedonia</option> <option value="MG" >Madagascar</option> <option value="MW" >Malawi</option> <option value="MY" >Malaysia</option> <option value="MV" >Maldives</option> <option value="ML" >Mali</option> <option value="MT" >Malta</option> <option value="MH" >Marshall Islands</option> <option value="MQ" >Martinique</option> <option value="MR" >Mauritania</option> <option value="MU" >Mauritius</option> <option value="MX" >Mexico</option> <option value="FM" >Micronesia, Federated States of</option> <option value="MC" >Monaco</option> <option value="MN" >Mongolia</option> <option value="MS" >Montserrat </option> <option value="MA" >Morocco</option> <option value="MZ" >Mozambique</option> <option value="MM" >Myanmar</option> <option value="NA" >Namibia</option> <option value="NR" >Nauru</option> <option value="NP" >Nepal</option> <option value="AN" >Netherlands Antilles</option> <option value="NC" >New Caledonia</option> <option value="NZ" >New Zealand</option> <option value="NI" >Nicaragua</option> <option value="NE" >Niger</option> <option value="NG" >Nigeria</option> <option value="NU" >Niue</option> <option value="GB" >Northern Ireland</option> <option value="NO" >Norway</option> <option value="OM" >Oman</option> <option value="PK" >Pakistan</option> <option value="PW" >Palau</option> <option value="PS" >Palestinian National Authority</option> <option value="PA" >Panama</option> <option value="PG" >Papua New Guinea</option> <option value="PY" >Paraguay</option> <option value="CN" >People's Republic of China</option> <option value="PE" >Peru</option> <option value="PH" >Philippines</option> <option value="PN" >Pitcairn Island</option> <option value="PL" >Poland</option> <option value="PT" >Portugal</option> <option value="QA" >Qatar</option> <option value="AM" >Republic of Armenia</option> <option value="AZ" >Republic of Azerbaijan</option> <option value="BY" >Republic of Belarus</option> <option value="BJ" >Republic of Benin</option> <option value="CG" >Republic of Congo</option> <option value="DJ" >Republic of Djibouti</option> <option value="KZ" >Republic of Kazakhstan</option> <option value="KR" >Republic of Korea</option> <option value="MD" >Republic of Moldova</option> <option value="ME" >Republic of Montenegro</option> <option value="RS" >Republic of Serbia</option> <option value="" >Republic of South Sudan</option> <option value="SD" >Republic of Sudan</option> <option value="TJ" >Republic of Tajikistan</option> <option value="UZ" >Republic of Uzbekistan</option> <option value="YE" >Republic of Yemen</option> <option value="RE" >Reunion</option> <option value="RO" >Romania</option> <option value="RU" >Russia</option> <option value="RW" >Rwanda</option> <option value="KN" >Saint Kitts and Nevis</option> <option value="LC" >Saint Lucia</option> <option value="VC" >Saint Vincent and The Grenadines</option> <option value="SM" >San Marino</option> <option value="ST" >Sao Tome And Principe</option> <option value="SA" >Saudi Arabia</option> <option value="GB" >Scotland</option> <option value="SN" >Senegal</option> <option value="SC" >Seychelles</option> <option value="SL" >Sierra Leone</option> <option value="SG" >Singapore</option> <option value="" >Sint Maarten</option> <option value="SK" >Slovakia</option> <option value="SI" >Slovenia</option> <option value="SB" >Solomon Islands</option> <option value="SO" >Somalia</option> <option value="ZA" >South Africa</option> <option value="ES" >Spain</option> <option value="LK" >Sri Lanka</option> <option value="SR" >Surinam</option> <option value="SZ" >Swaziland</option> <option value="SE" >Sweden</option> <option value="CH" >Switzerland</option> <option value="SY" >Syria</option> <option value="TW" >Taiwan</option> <option value="TZ" >Tanzania</option> <option value="TH" >Thailand</option> <option value="GM" >The Gambia</option> <option value="NL" >The Netherlands</option> <option value="TG" >Togo</option> <option value="TO" >Tonga</option> <option value="TT" >Trinidad and Tobago</option> <option value="TN" >Tunisia</option> <option value="TR" >Turkey</option> <option value="TM" >Turkmenistan</option> <option value="TC" >Turks and Caicos Islands</option> <option value="TV" >Tuvalu</option> <option value="US" selected="selected" >USA</option> <option value="UG" >Uganda</option> <option value="UA" >Ukraine</option> <option value="AE" >United Arab Emirates</option> <option value="UY" >Uruguay</option> <option value="VU" >Vanuatu</option> <option value="VE" >Venezuela</option> <option value="VN" >Vietnam</option> <option value="GB" >Wales</option> <option value="" >Zaire</option> <option value="ZM" >Zambia</option> <option value="ZW" >Zimbabwe</option> </select> <input type="text" aria-hidden="true" class="copy-target" id="bill_to_address_country" name="bill_to_address_country" value="US" placeholder="bill_to_address_country" data-field-signed="signed" /> </div> </div> </div> </div> <div class="row"> <div class="col col-xs-12"> <div> <div class="form-group"> <label for="contactStreet1" class="olg-section__label"> Street 1 <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <input type="text" name="ship_to_address_line1" id="contactStreet1" value="" autocomplete="address-line1" maxlength="40" class="form-control olg__textfield" data-copytarget="bill_to_address_line1" data-field-signed="signed" data-caption="Street 1" required="required"/> <div class="invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Contact Street 1 is required</span> </div> <input type="text" aria-hidden="true" class="copy-target" id="bill_to_address_line1" name="bill_to_address_line1" value="" autocomplete="off" placeholder="bill_to_address_line1" data-field-signed="signed"/> </div> </div> </div> </div> <div class="row"> <div class="col col-xs-12"> <div> <div class="form-group"> <label for="contactStreet2" class="olg-section__label"> Street 2 </label> <input type="text" name="ship_to_address_line2" id="contactStreet2" value="" autocomplete="address-line2" maxlength="40" class="form-control olg__textfield" data-copytarget="bill_to_address_line2" data-field-signed="signed" data-caption="Street 2"/> <input type="text" aria-hidden="true" class="copy-target" id="bill_to_address_line2" name="bill_to_address_line2" value="" autocomplete="off" placeholder="bill_to_address_line2" data-field-signed="signed"/> </div> </div> </div> </div> <div class="row"> <div class="col-sm-12 col-md-5"> <div> <div class="form-group"> <label for="contactCity" class="olg-section__label"> City <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <input type="text" name="ship_to_address_city" id="contactCity" value="" autocomplete="address-level2" maxlength="30" class="form-control olg__textfield" data-copytarget="bill_to_address_city" data-field-signed="signed" data-caption="City" required="required"/> <div class="invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Contact City is required</span> </div> <input type="text" aria-hidden="true" class="copy-target" id="bill_to_address_city" name="bill_to_address_city" value="" autocomplete="off" placeholder="bill_to_address_city" data-field-signed="signed"/> </div> </div> </div> <div class="col-sm-12 col-md-3"> <div> <div class="form-group"> <label for="contactState" class="olg-section__label"> State <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <input type="text" name="ship_to_address_state" id="contactState" value="" autocomplete="address-level1" maxlength="2" class="form-control olg__textfield" data-copytarget="bill_to_address_state" data-field-signed="signed" data-transform="uppercase" data-caption="State" required="required"/> <div class="invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Contact State is required</span> </div> <input type="text" aria-hidden="true" class="copy-target" id="bill_to_address_state" name="bill_to_address_state" value="" autocomplete="off" placeholder="bill_to_address_state" data-field-signed="signed"/> </div> </div> </div> <div class="col-sm-12 col-md-4"> <div> <div class="form-group"> <label for="contactPostCd" class="olg-section__label"> ZIP Code <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <input type="text" pattern="^\d{5}(-\d{4})?$" name="ship_to_address_postal_code" id="contactPostCd" value="" autocomplete="postal-code" class="form-control olg__textfield" data-copytarget="bill_to_address_postal_code" data-field-signed="signed" data-caption="ZIP Code" required="required"/> <div class="invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Contact Zip Code is required</span> </div> <input type="text" aria-hidden="true" class="copy-target" id="bill_to_address_postal_code" name="bill_to_address_postal_code" value="" autocomplete="off" placeholder="bill_to_address_postal_code" data-field-signed="signed"/> </div> </div> </div> </div> <div class="row"> <div class="col-sm-12 col-md-6"> <div> <div class="form-group"> <label for="bill_to_email" class="olg-section__label"> Contact Email <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <input type="email" name="bill_to_email" id="bill_to_email" value="" autocomplete="email" maxlength="255" class="form-control olg__textfield" data-field-signed="signed" data-validation="validateEmail" data-caption="Contact Email" onkeyup="olgDonor2.checkForCustomFieldErrors(this)" required="required"/> <div class="invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Invalid email address</span> </div> </div> </div> </div> </div> <div class="row"> <div class="col-sm-12 col-md-6"> <div> <div class="form-group"> <label for="contactPhone" class="olg-section__label"> Daytime Phone Number <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <input type="tel" name="bill_to_phone" id="contactPhone" value="" autocomplete="tel" maxlength="20" class="form-control olg__textfield" data-field-signed="signed" data-validation="validateDonorContactPhone" data-caption="Daytime Phone Number" onkeyup="olgDonor2.checkForCustomFieldErrors(this)" required="required"/> <div class="invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Valid Contact Phone Number is required</span> </div> </div> </div> </div> </div> </div> </section> </div>  <div class="col-xs-12 col-lg-3"> <div class="sticky-top panel ace-olg-your-donation sum-box"> <div class="sum-box__container">  <div class="row "> <div class="col sum-box__info text-center"> <input type="hidden" id="recaptchaResponse" name="recaptchaResponse"/>   <div class="sum-box__title"><span>Your Donation</div> <div class="sum-box__amount" id="amount"></div> <div id="giftCompleteInfo" class="sum-box__msg" giftSummaryCaption="Harvard University Health Services">Please Select a Recipient</div> <hr /> <input type="button" class="g-recaptcha btn btn-olg-complete btn-block sum-box__button sum-box__button--complete" value="Complete Your Gift" /> </div> </div>  <div class="row sum-box__errors"> <div class="col"> <div id="error-msgs" role="alert"></div> </div> </div> </div> </div> </div> </div>  <div class="row" > <div class="col-xs-12"> <div id="hidden-stuff" class="collapse"> <div style="display:block"> <hr /> <br/> <div>Recurring Gift Info</div> <b>recurring_amount:</b> <input type="text" data-field-signed="" name="recurring_amount" id="recurring_amount" value=""/> <br/><b>recurring_frequency:</b> <input type="text" data-field-signed="" name="recurring_frequency" id="recurring_frequency" value=""/> <br/><b>recurring_start_date:</b> <input type="text" data-field-signed="" name="recurring_start_date" id="recurring_start_date" value=""/> </div> <div class="cyber-hidden-fields" id="cyber-hidden-fields" style="display:block"> <br /> <div>Cybersource Stuff <small class="text-muted">Shown here but will not be visible in final implementation</small></div> <b>Gift/Membership Amount:</b> <input type="hidden" name="amount_temp" id="amount_temp" autocomplete='off'/> <input type="hidden" name="amount" id="amount_field" data-field-signed='' value="" autocomplete='off'/> <b>signed_date_time:</b> <input type="text" data-field-signed="" name="signed_date_time" id="signed_date_time" value=""/> <br/><b>signed_field_names:</b> <input type="text" data-field-signed="" name="signed_field_names" id="signed_field_names" value=""/> <br/><b>transaction_type:</b> <input type="text" data-field-signed="" name="transaction_type" id="transaction_type" value="sale"/> <br/><b>transaction_uuid:</b> <input type="text" data-field-signed="" name="transaction_uuid" id="transaction_uuid" value=""/> <br/><b>unsigned_field_names:</b> <input type="text" data-field-signed="" name="unsigned_field_names" id="unsigned_field_names" value=""/> <br/><b>profile_id:</b> <input type="text" data-field-signed="" name="profile_id" id="profile_id" value="EDEF5F13-8BC0-4E30-BBE9-E76770B7E501"/> <br/><b>CSRF Token:</b> <input name="_csrf" value="1a660d20-a595-48c5-b711-c9ef4b87e854"/> <br/><b>reference_number:</b> <input type="text" data-field-signed="" name="reference_number" id="reference_number" value=""/> <br/><b>ignore_avs:</b> <input type="text" data-field-signed="" name="ignore_avs" id="ignore_avs" value="false"/> <br/><b>ignore_cvn:</b> <input type="text" data-field-signed="" name="ignore_cvn" id="ignore_cvn" value="false"/> <br/><b>Access Key:</b> <input type="text" data-field-signed="" name="access_key" id="access_key" value="42a071f43c813bba9a0ab462880a00bb"/> <br/><b>Currency:</b> <input type="text" data-field-signed="" name="currency" id="currency" value="USD"/> <br/><b>Locale:</b> <input type="text" data-field-signed="" name="locale" id="locale" value="en"/> <br/><b>appeal_code:</b> <input type="text" data-field-merchant="" name="appeal_code" id="appeal_code" value="UNV15"/> <br/><b>payment_method:</b> <input type="text" data-field-signed="" name="payment_method" id="payment_method" value="card"/> <br/><b>form_id:</b> <input type="text" data-field-merchant="" name="form_id" id="form_id" value="65401554"/> <input type="hidden" name="ignore_mcJobID" id="ignore_mcJobID" data-field-merchant='' value=" " autocomplete='off'/> <input type="hidden" name="ignore_mcListID" id="ignore_mcListID" data-field-merchant='' value=" " autocomplete='off'/> <input type="hidden" name="ignore_mcEmail" id="ignore_mcEmail" data-field-merchant='' value=" " autocomplete='off'/> <input type="hidden" name="ignore_mcLinkID" id="ignore_mcLinkID" data-field-merchant='' value=" " autocomplete='off'/> <input type="hidden" name="ignore_mcBatchID" id="ignore_mcBatchID" data-field-merchant='' value=" " autocomplete='off'/> <input type="hidden" name="ignore_mcMemberID" id="ignore_mcMemberID" data-field-merchant='' value=" " autocomplete='off'/>  <input type="hidden" name="ignore_mcSubscriberId" id="ignore_mcSubscriberId" data-field-merchant='' value=" " autocomplete='off'/>  <input type="hidden" name="ignore_origRequestUrl" id="ignore_origRequestUrl" data-field-merchant='' value="orig path= https://community.alumni.harvard.edu/give/65401554, orig seq= 0" autocomplete='off'/> <input type="hidden" name="ignore_redirectParameters" id="ignore_redirectParameters" data-field-merchant='' value="opath=https%3A%2F%2Fcommunity.alumni.harvard.edu%2Fgive%2F65401554" autocomplete='off'/> </div> </div> <hr /> </div> </div> </form> </div> </div>  <div class='olg-footer hidden-print'> <div class="container"> <footer role="contentinfo" class="other-ways col-xs-24"> <h2 class="underline-header"><span>Other Ways To Give</h2> <div> <p>If you encounter difficulties giving online, please contact Harvard University Health Services (HUHS) at 617-495-2010. </p> </div> </footer> </div> </div>  <div class='olg-sub-footer hidden-print'> <div class="container footer-nav-wrap"> <div class="row"> <div class="col-lg-4"> <div> <div id="block-footerleftcolhtml" class="block block-block-content block-block-content61a48aee-f9c6-42a2-bd54-72ea45749b21"> <h2 class="block-title h4">Social Media</h2> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><div class="social-links"><a class="twitter" href="https://twitter.com/HarvardAlumni">Twitter</a> <a class="youtube" href="https://www.youtube.com/HarvardAlumni">Youtube</a> <a class="facebook" href="https://www.facebook.com/harvardalumniassoc/">Facebook</a> <a class="linkedin" href="https://www.linkedin.com/groups/5121870">LinkedIn</a> <a class="instagram" href="https://www.instagram.com/harvardalumni/">Instagram</a></div> </div> </div> </div> </div> <div class="col-lg-4"> <div> <nav aria-labelledby="block-d8footermenugethelp-menu" id="block-d8footermenugethelp" class="block block-menu navigation menu--menu-footer-menu-help"> <h2 class="h4 block-title" id="block-d8footermenugethelp-menu">Get Help</h2> <ul class="menu"> <li class="menu-item"> <a href="https://community.alumni.harvard.edu/contact-us" title="">Contact the alumni service desk</a> </li> <li class="menu-item"> <a href="/help/site-access/registration" title="" data-drupal-link-system-path="node/1187">Claim your HarvardKey</a> </li> <li class="menu-item"> <a href="/help/directory-search" title="" data-drupal-link-system-path="node/1178">Get help searching the alumni directory</a> </li> <li class="menu-item"> <a href="/help/contacts-links" title="" data-drupal-link-system-path="node/1186">View all contacts</a> </li> <li class="menu-item"> <a href="/help" title="" data-drupal-link-system-path="node/1175">View all help pages</a> </li> </ul> </nav> </div> </div> <div class="col-lg-4"> <div> <nav aria-labelledby="block-d8footermenuaboutthissite-menu" id="block-d8footermenuaboutthissite" class="block block-menu navigation menu--menu-footer-menu-about-site"> <h2 class="h4 block-title" id="block-d8footermenuaboutthissite-menu">About This Site</h2> <ul class="menu"> <li class="menu-item"> <a href="https://accessibility.huit.harvard.edu/digital-accessibility-policy" title="">Accessibility</a> </li> <li class="menu-item"> <a href="/privacy" title="" data-drupal-link-system-path="node/4">Privacy</a> </li> <li class="menu-item"> <a href="/terms" title="" data-drupal-link-system-path="node/3">Terms of Use</a> </li> <li class="menu-item"> <a href="/feedback" data-drupal-link-system-path="node/1199">Feedback</a> </li> <li class="menu-item"> <a href="https://www.harvard.edu/" title="">Go to Harvard.edu</a> </li> <li class="menu-item"> <a href="/user/login" title="" data-drupal-link-system-path="user/login">Admin Profile</a> </li> </ul> </nav> </div> </div> </div> </div> <p class="olg-servernum hidden-print">2</p> <p class="copyright">© <span>2024</span> <span>The President and Fellows of Harvard College</span></p> </div>  <div class="modal fade" id="timeout-modal" data-keyboard="false"> <div class="olg-modal modal-dialog modal-sm"> <div class="olg-modal__content modal-content"> <div class="olg-modal__header modal-header"> <p class="olg-modal__heading--4 modal-title">Session Timeout Approaching</p> <button type="button" class="olg-modal__button--close close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button> </div> <div class="olg-modal__body modal-body"> <p>For security reasons, your session will end in a few minutes. Select OK to continue editing.</p> </div> <div class="olg-modal__footer modal-footer"> <button type="button" class="olg-modal__button--primary btn btn-primary" data-dismiss="modal">OK</button> </div> </div> </div> </div>  <div class="modal fade" id="timeout-expired-modal" data-keyboard="false"> <div class="olg-modal modal-dialog modal-sm"> <div class="olg-modal__content modal-content"> <div class="olg-modal__header modal-header"> <p class="olg-modal__heading--4 modal-title">Your Session Has Timed Out</p> <button type="button" class="olg-modal__button--close close" data-dismiss="modal" aria-label="Close" onclick="location.reload(true);"><span aria-hidden="true">×</span></button> </div> <div class="olg-modal__body modal-body"> <p>For security reasons, your session has been timed-out. Select OK to refresh the page and try again.</p> </div> <div class="olg-modal__footer modal-footer"> <button type="button" class="olg-modal__button--primary btn btn-primary" data-dismiss="modal" onclick="location.reload(true);">OK</button> </div> </div> </div> </div>  <div class="modal fade" role="dialog" aria-labelledby="recent-title" id="recent-modal" data-keyboard="false"> <div class="olg-modal modal-dialog modal-sm" role="document"> <div class="olg-modal__content modal-content"> <div class="olg-modal__header modal-header"> <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button> <p class="olg-modal__heading--4 modal-title" id="recent-title">Confirm Gift?</p> </div> <div class="olg-modal__body modal-body"> <p>We see that you just gave a similar gift. Are you sure you want to proceed and give another one?</p> </div> <div class="olg-modal__footer modal-footer"> <button type="button" id="recent.confirmationButton" class="olg-modal__button--primary btn btn-primary" data-dismiss="modal">Yes, make gift</button> <button type="button" id="recent.cancelButton" class="olg-modal__button--primary btn btn-primary" data-dismiss="modal">Cancel</button> </div> </div> </div> </div> <script src="/assets/js/olg2vendor-533a567f67a00554e57c82ba7bb22c5a.js;jsessionid=1GBvRjTXS2w1HTiF8BWDED6V84YyucPgxzz9a7gRuyMq4ejwGGQR!-744387992"></script> <script src="/assets/js/olg2-a99da23889110253cafa9c22c6918bd7.js;jsessionid=1GBvRjTXS2w1HTiF8BWDED6V84YyucPgxzz9a7gRuyMq4ejwGGQR!-744387992"></script> <script type="text/template" class="template" id='addlGiftAmts'> <div id="your-gift-group-{{=counter}}" class="your-gift-group olg-gift__group collapse"> <div class="col-xs-12"> <hr class="gift-separator" /> <div class="your-gift-amount-selector olg-gift__amounts form-group"> <div class="your-gift-amount-control col-xs-12"> <fieldset class="container"> <div class="row"> <div class="col-xs-12 pl-0 olg-section__label"> <legend class="sr-only">Gift Amount Options. Please select a Gift Amount, Harvard School or Affiliate, and a fund where your gift should be directed. </legend> <span>Additional Gift</span> </div> </div> <div class="js-button-row"> <div class="btn-group-toggle row align-items-center" data-toggle="buttons"> <label class="col-sm btn btn-olg-selector olg-gift__button olg-gift__button--amt form-control active" active="active"> <input type="radio" class="js-amt-button js-amt" name="donationAmt_{{=counter}}" id="gift{{=counter}}btn_51710191" value="25.0" checked="checked"/> $25 </label> <label class="col-sm btn btn-olg-selector olg-gift__button olg-gift__button--amt form-control"> <input type="radio" class="js-amt-button js-amt" name="donationAmt_{{=counter}}" id="gift{{=counter}}btn_51710192" value="50.0"/> $50 </label> <label class="col-sm btn btn-olg-selector olg-gift__button olg-gift__button--amt form-control"> <input type="radio" class="js-amt-button js-amt" name="donationAmt_{{=counter}}" id="gift{{=counter}}btn_51710193" value="100.0"/> $100 </label> <label class="col-sm btn btn-olg-selector olg-gift__button olg-gift__button--amt form-control"> <input type="radio" class="js-amt-button js-amt" name="donationAmt_{{=counter}}" id="gift{{=counter}}btn_51710194" value="500.0"/> $500 </label> <label class="col-sm btn btn-olg-selector olg-gift__button olg-gift__button--amt form-control"> <input type="radio" class="js-amt-button js-amt" name="donationAmt_{{=counter}}" id="gift{{=counter}}btn_51710195" value="1000.0"/> $1,000 </label> <div class="form-group col-sm-3 col-md-2 your-gift-amount-input olg-gift__amt-container"> <label for="otherAmount_{{=counter}}" class="olg-section__label"> Other Amount </label> <input id="otherAmount_{{=counter}}" inputmode="decimal" class="form-control other-amt olg__textfield olg__textfield--number js-gift-other-amt" maxlength="9" value="" /> </div> </div> <input type="text" value="25.0" autocomplete="off" name="donation-amt-{{=counter}}" id="donation-amt-{{=counter}}" class="donationAmt form-control mostly-hidden" tabindex="-1" data-field-merchant="" data-validation="validateGiftAmt" /> <div class="invalid-feedback row"> <i class='fa fa-exclamation-circle'></i><span class="js-invalid-feedback-msg js-gift-amt-msg"/> </div> </div> </fieldset> </div> </div> <div class="row"> <div class="form-group col-xs-12 col-md-8 olg-gift__school-fund"> <label for="school_{{=counter}}" class="olg-section__label" > Select a School / Affiliate <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <select class='form-control init-select2 js-schoolSelect' id="school_{{=counter}}" name="school_{{=counter}}" style="width:100%" data-field-merchant="merchant" data-validation="validateSchool" required="required"> <option value="">Select a School or Affiliate</option> <option value="ARB" >Arnold Arboretum</option> <option value="ATH" >FAS Athletics</option> <option value="FAS" >Faculty of Arts and Sciences</option> <option value="GSD" >Graduate School of Design</option> <option value="GSE" >Graduate School of Education</option> <option value="UAM" >Harvard Art Museums</option> <option value="HBS" >Harvard Business School</option> <option value="COL" >Harvard College</option> <option value="HDS" >Harvard Divinity School</option> <option value="EXT" >Harvard Extension School </option> <option value="GSA" >Harvard Griffin Graduate School of Arts and Sciences</option> <option value="KSG" >Harvard Kennedy School</option> <option value="HLS" >Harvard Law School</option> <option value="HMS" >Harvard Medical School</option> <option value="ZZZ" >Harvard Museums of Science & Culture</option> <option value="SDM" >Harvard School of Dental Medicine</option> <option value="SPH" >Harvard T.H. Chan School of Public Health</option> <option value="DAS" >Harvard's Paulson School of Engineering and Applied Sciences</option> <option value="MEM" >Memorial Church</option> <option value="NIE" >Nieman Foundation</option> <option value="ND" >Non-Departmental</option> <option value="RDI" >Radcliffe Institute</option> <option value="UNV" >University</option> <option value="VIT" >Villa I Tatti</option> </select> <div class="invalid-feedback fund1-invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >School is required</span> </div> </div> </div> <div class="row"> <div class="form-group col-xs-12 col-md-8 olg-gift__school-fund"> <label for="fund_{{=counter}}" class="olg-section__label" > Select a Fund <span aria-hidden="true"> *</span> <span class="sr-only"> required</span> </label> <select class='form-control init-select2 js-fund' id="fund_{{=counter}}" name="fund_{{=counter}}" style="width:100%" data-field-merchant="merchant" data-validation="validateFund" required="required"> <option value="" disabled="disabled">Select a Fund</option> </select> <div class="invalid-feedback fund1-invalid-feedback"> <i class='fa fa-exclamation-circle'></i> <span class="js-invalid-feedback-msg" >Fund is required</span> </div> </div> </div> </div> <div class="col-xs-12"> <input class="btn btn-sm js-delete-gift olg-gift__button olg-gift__button--remove" type="button" value="Remove this gift" /> </div> </div> </script> <script> /*<![CDATA[*/ function updateOnLoad(){ if ($('#membAddlGiftInput').length > 0 && $('#membAddlGiftInput').val().trim().length > 0) { $('#membAddlGiftInput').change(); } if ($('.js-gift-other-amt').length > 0 && $('.js-gift-other-amt').val().trim().length > 0) { $('.js-gift-other-amt').change(); } olgGift2.setGiftCommentVisibility(); } if(window.addEventListener){ window.addEventListener('load',updateOnLoad,false); //W3C } else{ window.attachEvent('onload',updateOnLoad); //IE } /*]]>*/ </script> </body> </html>