CONTACT INFORMATION

Name of Contact Person*:

Title:

Organization/Company:

Address*:

City, State & Zip*:

County*:

Phone Number*:

E-mail Address*:

PLEDGE INFORMATION

Unrestricted Contribution
Please consider an unrestricted contribution to underwrite the administrative support required to operate the program.

Unrestricted Amount:

$

Scholarship Contribution ($450 per participant)

You may designate your scholarship dollars for a student, school, student or county.
Please note: while every effort will be made to match scholarships as requested, if no student is enrolled that would match your request, the Foundation reserves the right to allocated scholarships to students in need.

Scholarship Amount:

$

Assign:

$

Financial Aid Program Support

Please earmark this contribution to help underwrite the Financial Aid Program.

Financial Aid Amount:

$

Total Amount*:

$

PLEDGE INFORMATION

Is this contribution on behalf of your organization/company or a personal contribution?*

Organization/Company contribution
Personal contribution

What is your method of payment? (choose one)*

I am mailing in my contribution on (date).

Please send me an invoice on (date).

Please call me on (date) and I will give you my credit card information.

Please send me additional information about volunteer opportunities (check all that apply):

Company advisor

Speaker

Consultant

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