Title:    _____ Mr.     _____Mrs.    _____Miss    _____Ms.      _____Dr.

First Name(s):                                                                                       Middle Initial:

Last Name:

Street/Apt. #:

City:                                                                  State:                                               Zip Code:     

E-mail Address:

Daytime Phone Number:____________________________ Home Phone Number:__________________________

Name of Business or Company (if applicable):

Gift Designation (check one):

   ___ Donation, Undesignated

   ___ 5K/15K/Mini-K Fun Run Donation

   ___ Honorary Gift for __________________________

   ___ Circle of Success Donation

   ___ Memorial Gift for __________________________

   ___ Technology

   ___ Teacher Excellence Endowment Fund

   ___ Curriculum & Student Development

Donation Amount:  $______________      _____Check Enclosed (Ck #_________)    _____ Cash

 _____Payroll Deduction (SISD employees only).    Please deduct $_____________from my monthly check.

Pledge Amount:  $______________ Payable within one year unless other arrangements are made.

Comments: 

Signature:______________________________________________ Date:________________________________