Scholarship Donation Form

Please provide the following contact information:

Name

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

FAX

E-mail

I graduated from:

MHS

Other

Year Graduated

I would like to establish a scholarship fund for the following person(s):

Name of Person(s)
Name of Scholarship
Amount of Scholarship
I would like to contribute a scholarship fund for the following :
Specify what scholarship program you would like the funds to benefit (Choose only one ):
Additional Comments (if any):
*Either submit this form and we will contact you about your donation, or print this form out and mail it to the address at the bottom of the page along with your tax deductible donation.*