Donor Survey

First Name

Email *

Primary Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

How would you like to hear from your Foundation liason?

Phone
Email
Either Phone or Email

Would you like to receive information about any of the following?

Giving Societies
Events
Specific division or area of the hospital
I would not like to receive information from Children's Hospital of Pittsburgh Foundation.

Would you like to learn more about how you can make a gift through any of these vehicles?

Donor Advised Fund
Leaving Children’s in your Estate
IRA
Appreciated Securities (Stock)

Of Children’s core mission areas, what motivates you to support us?

Research
Clinical Care
Patient Experience
Other

What inspired you to start supporting Children’s?

Do you have a Children’s story or experience you would like to share?

What has most motivated your giving to UPMC Children’s Hospital Foundation? Please select statements that apply to you and rate on a scale of 1-5, with 5 being “most important” and 1 being “not important.”

	5 - Most Important	4	3	2	1 - Least Important
A family member/child was treated at UPMC Children’s Hospital of Pittsburgh.	A family member/child was treated at UPMC Children’s Hospital of Pittsburgh. 5 - Most Important	A family member/child was treated at UPMC Children’s Hospital of Pittsburgh. 4	A family member/child was treated at UPMC Children’s Hospital of Pittsburgh. 3	A family member/child was treated at UPMC Children’s Hospital of Pittsburgh. 2	A family member/child was treated at UPMC Children’s Hospital of Pittsburgh. 1 - Least Important
I volunteer and have seen first-hand how UPMC Children's impacts lives.	I volunteer and have seen first-hand how UPMC Children's impacts lives. 5 - Most Important	I volunteer and have seen first-hand how UPMC Children's impacts lives. 4	I volunteer and have seen first-hand how UPMC Children's impacts lives. 3	I volunteer and have seen first-hand how UPMC Children's impacts lives. 2	I volunteer and have seen first-hand how UPMC Children's impacts lives. 1 - Least Important
UPMC Children’s provides all children access to care regardless of their family’s financial situation.	UPMC Children’s provides all children access to care regardless of their family’s financial situation. 5 - Most Important	UPMC Children’s provides all children access to care regardless of their family’s financial situation. 4	UPMC Children’s provides all children access to care regardless of their family’s financial situation. 3	UPMC Children’s provides all children access to care regardless of their family’s financial situation. 2	UPMC Children’s provides all children access to care regardless of their family’s financial situation. 1 - Least Important
UPMC Children’s conducts cutting edge research.	UPMC Children’s conducts cutting edge research. 5 - Most Important	UPMC Children’s conducts cutting edge research. 4	UPMC Children’s conducts cutting edge research. 3	UPMC Children’s conducts cutting edge research. 2	UPMC Children’s conducts cutting edge research. 1 - Least Important
The world-class care at UPMC Children’s means that children have local access to exceptional care.	The world-class care at UPMC Children’s means that children have local access to exceptional care. 5 - Most Important	The world-class care at UPMC Children’s means that children have local access to exceptional care. 4	The world-class care at UPMC Children’s means that children have local access to exceptional care. 3	The world-class care at UPMC Children’s means that children have local access to exceptional care. 2	The world-class care at UPMC Children’s means that children have local access to exceptional care. 1 - Least Important
UPMC Children’s doctors, nurses, and medical providers are consistently recognized at the top of their fields.	UPMC Children’s doctors, nurses, and medical providers are consistently recognized at the top of their fields. 5 - Most Important	UPMC Children’s doctors, nurses, and medical providers are consistently recognized at the top of their fields. 4	UPMC Children’s doctors, nurses, and medical providers are consistently recognized at the top of their fields. 3	UPMC Children’s doctors, nurses, and medical providers are consistently recognized at the top of their fields. 2	UPMC Children’s doctors, nurses, and medical providers are consistently recognized at the top of their fields. 1 - Least Important
I want to provide general support to UPMC Children’s.	I want to provide general support to UPMC Children’s. 5 - Most Important	I want to provide general support to UPMC Children’s. 4	I want to provide general support to UPMC Children’s. 3	I want to provide general support to UPMC Children’s. 2	I want to provide general support to UPMC Children’s. 1 - Least Important
I want to honor/remember a loved one.	I want to honor/remember a loved one. 5 - Most Important	I want to honor/remember a loved one. 4	I want to honor/remember a loved one. 3	I want to honor/remember a loved one. 2	I want to honor/remember a loved one. 1 - Least Important
I like the tax advantages of giving.	I like the tax advantages of giving. 5 - Most Important	I like the tax advantages of giving. 4	I like the tax advantages of giving. 3	I like the tax advantages of giving. 2	I like the tax advantages of giving. 1 - Least Important

If something else has motivated your giving to UPMC Children's Hospital Foundation that is not listed above, please share it here:

Where does UPMC Children’s Hospital Foundation rank in terms of your philanthropic priorities? Please rate on a scale of 1-5, with 5 being “most important” and 1 being “not important.”

	5 - Most Important	4	3	2	1 - Least Important
Rank	Rank 5 - Most Important	Rank 4	Rank 3	Rank 2	Rank 1 - Least Important

What other causes are important to you?

We know that many of our donors have included UPMC Children’s Hospital Foundation and other charities in their estate plans to leave a lasting legacy for causes they deeply care about.

Have you included UPMC Children’s Hospital Foundation in your estate plans?

Yes, I have included a gift to UPMC Children’s Hospital Foundation in my estate plans.
No, I have not included a gift to UPMC Children’s Hospital Foundation in my estate plans.

If you have not included UPMC Children’s Hospital Foundation in your estate plans, would you be willing to consider doing so?

Yes, please send me more information.
No, I have included other charities in my estate plan.
I do not have an estate plan at this time.

Is there anything you would like to share about our work, mission or your experience as a donor?

What financial vehicles do you use to support charities? (check all that apply)

What do you hope to learn more about at UPMC Children’s?

Last Name

Phone

Seasonal Address (If Applicable)