Neurobiology and Anatomy > Department Administration > Willed Body Program > Donor Forms

Willed Body Program: General Information | Questions | Donor Forms | Contact Us

Program Donor Form

How to complete the Donor Form and Special Request Form:

1. Download this file - Donor Form and Special Request Form
   (NOTE: The Special Request Form deals with the return of cremains.)
2. Open it in Adobe Acrobat or Adobe Acrobat Reader.
   (NOTE: If you do not currently have a copy of Adobe Acrobat or Acrobat Reader, you can download and use the Adobe Acrobat Reader program for free. Click here to download it.)
3. Print the forms out using your printer.
4. Fill out BOTH pages of the Form and sign it.
5. Have two (2) witnesses also sign the form.
   (Remember to designate a NEXT OF KIN at the bottom of the first page, and to fill out the 2nd page as well.)
6. Mail the original forms to:

   Willed Body Program
   6431 Fannin  Suite 7.046
   Houston, TX  77030

Please do not hesitate to contact me if you have any questions:

John D. Concha
Coordinator, Willed Body Program
The University of Texas Health Science Center at Houston
6431 Fannin Suite 7.046
Houston, Texas 77030
713-500-5603 Phone
713-500-0522 Fax
713-716-4414 Pager
john.d.concha@uth.tmc.edu E-Mail
7137164414@archwireless.net Alpha Page Text Messaging

 

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Date Last Modified: November 19, 2009 9:36 AM

 

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