York Student Enrichment Program

Active Students, Involved Students, Every Student Donor Information (please print or type)
Name Street Address City, State, ZIP Telephone E-Mail

Donation Information (All Donations Are Tax Deductible)

I (we) wish to make a one-time donation in the amount of (please circle): $5,000 $2,500 $1,000 $500 $250 $100 $50 Other $____________________

Method of Payment
Check enclosed. Please make check payable to District 205 Foundation (YSEP) Please bill my credit card: VISA MASTERCARD

Credit card number Expiration date Authorized signature

Gift will be matched by ________________________________ (company/family/foundation). Acknowledgement Information Please use the following name(s) in all acknowledgements: _____________________________ I (we) wish to have our gift remain anonymous.
Date _________________________

Signature(s) ____________________________________

Mail completed form and/or checks to:

District 205 Foundation, 162 S. York Street, Elmhurst IL 60126

For additional information contact Deb Conroy conroydeb@yahoo.com Margaret Harrell mdharrell@att.net Nancy Ruprecht nruprecht@comcast.net Deb Webb debwebb168@gmail.com

630.917.1631 630.240.7315 630.215.4862 630.670.5681