Scholarship Sponsorship form

SCHOLARSHIP PROGRAM FUND FORM

Donor Information

Name

Street Address

City, State, and Zip Code

Home Phone

Cell Phone

E-Mail

Life Time Member:

Life Time Member

Yes No

Pledge Information

I (we) Pledge a Total $

for

Years

I (we) plan to make this contribution in the form of

I (we) plan to make this contribution in the form of: Cash ☐ Check ☐

Cash Check

Acknowledgement Information

I by my signature below acknowledge this donation for SLKPS SCHOLARSHIP PROGRAM

Signature(s)

Date

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