School of Medicine

Wayne State University School of Medicine

Donor Form & Instructions

When completing your bequest forms, please make sure the following items are included:

  • Your hand-written signature and date with your name, address, and telephone number typed or printed on the five appropriate lines.
  • The lower portion of the bequest form pertains to Health, Department Records which is an aid in completing the death certificate. Please pay close attention and record accurate information on the appropriate lines.
  • A notation on the top margin of the bequest form if you have donated your corneas at any time to an eye-bank.
  • Signatures of TWO witnesses on the designated lines. Your spouse, and a family member or friend is a permissible witness as long as the individual is at least 18 years of age.
  • After completing both donor forms, please return ONE copy (WSU copy) to the Body Bequest Office. The other copy (Donor’s copy) should remain with the brochure for your records.
  • Upon receipt of the signed donor form, you will be sent a pocket-size donor card to be carried with you at all times. The card indicates enrollment in the program and the procedures to be followed in the event of death, so that Wayne State University School of Medicine will be notified without undue delay.

Donor Form Instructions

Donor Form - Donor Copy

Donor Form - WSU Copy