412.682.7757
- www.pa-cap.org
PA College
Access Program
Donation
Form
To make a
charitable contribution to PA CAP please fill out, print and mail this form,
along with your method of payment to:
PA-CAP ,
All
contributions will be acknowledged, in writing within 10 business days of receipt. If you are interested in making a major
Contribution
to PA-CAP or its endowment, please contact the PA-CAP
Main Office directly at (412) 682-7757.
You can
also designate your contribution to PA-CAP [#1280916] through the
DONOR CATEGORIES
Freshman
Up to $100 Senior $500-$999
Sophomore $100
- $249 Graduate $1000 - $4,999
Junior $250
- $499 Dean’s
List $5,000 or more
DONOR INFORMATION
First
Name:________________________ Last Name________________________________
Title:________________________
Organization (if
applicable):_________________________________________________________________________________
Address____________________________________________
City__________________ State_____ Zip Code______________
Phone__________________________________
Fax_____________________________ E-mail__________________________
Is your
gift mated?________ if yes please include the
following information:
My gift
will be matched by:__________________________________________________________________________________
Address_____________________________________________
City_________________ State______ Zip Code______________
Phone__________________________________
Fax_______________________________ E-mail__________________________
If you
would like to make your donation in honor or in memory of someone special,
please complete the following section.
PA-CAP
will send
a letter of acknowledgement to both parties.
Highlight
one (if applicable): In Honor of: In
Memory of:
Organization
(if applicable)___________________________________________________________________________________
Address______________________________________________
City _________________ State______ Zip Code_____________
Phone__________________________________
Fax_______________________________ E-mail__________________________
PAYMENT INFORMATION
I wish
to make a donation of__________________ (US Dollars) Form of Payment (Circle one) Check Money order