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Page 1 DONOR NAME: CONTACT NAME: CONTACT MAILING PLEDGE FORM SPONSORSPONSOR SCHOLRSCHOLR CONTACT INFORMATION DONOR NAME:_____________________________________________________ CONTACT NAME: ____________________________________________________ FIRST LAST FIRST LAST CONTACT MAILING ADDRESS:____________________________________________________________________________________________________________ CITY STATE ZIP CONTACT PERSON PREFERRED PHONE #:_____________ Home Cell Work CONTACT PERSON EMAIL ADDRESS:____________________________ SCHOLAR INFORMATION *Will be added to our e-newsletter list unless this box is checked: NAME OF SCHOLARSHIP:________________________________________________________________________________________________________________ I WISH FOR MY GIFT TO SUPPORT THE FOLLOWING: Please indicate with an “X”. GIFT AMOUNTS: $2,500 $5,000 $10,000 Other Technical College/Certificates Community College (Associates) SCHOLAR AMOUNTS: Community College (Associates) – Incentive for 15 Credits 4-year College/University __ # of Scholars I wish to support in this way 4-year College/University – Incentive for 15 Credits __ # of Academic Years I wish to support in this way YOU MAY CHOOSE TO SELECT A SPECIFIC CRITERIA FOR THE SCHOLAR(S) YOU ARE SPONSORING: I wish to support without specific restrictions I wish to support with the following criteria; Please select from criteria on the backside. Gender: ________________________________________________________ Ethnicity/Race: ________________________________________________ First Generation Student Status:___________________________________ High School:___________________________________________________ Institution:______________________________________________________ Major/Field of Study:___________________________________________ SPONSOR INFORMATION GIFT MATCHING OPTIONS: Match my gift by 100% with the Colorado Opportunity Scholarship Initiative (*If available) My company will match my gift. I will notify my HR department that I am making this gift. CONFIRMATION/PAYMENT INFORMATION: GIFT WILL BE PAID: I wish to confirm my total gift of $_________ to the Denver Scholarship In Total In Gift Installments of: $_____ on _____(date/s) Foundation with the purpose of designating it for this Scholarship. Through a multi-year committment ___2017___2018___2019___Other PAYMENT OPTIONS: Invoice. Please send me an invoice using the contact information listed above. Check. Please make payable to “Denver Scholarship Foundation” and place “Named Scholarship” in the memo line. Mail to Denver Scholarship Foundation, ATTN: Greg Movesian, 789 Sherman, Ste 610, Denver, CO 80203. Credit Card. VISA Master Card Discover American Express Name as it appears on the card:______________________________________ Card #:_________________________________ Exp. Date:______________ Billing Zip Code:_______________________________________________ Signature:_______________________________________________________ Date:_________________________________________________________ Gift of Stock – Please provide me with securities transfer instructions. Donor Advised Fund/Foundation. ACKNOWLEDGEMENT We agree that the above reflects the intent of the Donor and the Denver Scholarship Foundation. DONOR: CHIEF EXECUTIVE OFFICER, DENVER SCHOLARSHIP FOUNDATION: Responsible Party Printed Name:_____________________________ Nathaniel Easley, PhD. Responsible Party Signature:_________________________________ Signature:_____________________________________________________________ Date:_______________________________________________________ Date:__________________________________________________________________ PLEDGE FORM SPONSORSPONSOR SCHOLRSCHOLR THE DENVER SCHOLARSHIP FOUNDATION IS A 501(c)(3) PUBLIC CHARITY (#20-5143175) DONORS ARE INVITED TO SELECT ONE OR MORE DESIGNATION OPTIONS: (Please circle one.) One Scholar More than one Scholar Without specific restrictions First Generation GENDER: ETHNICITY: Male American Indian/Alaska Native Asian Black/African American Female Hispanic/Latino Pacific Islander/Native Hawaiian White HIGH SCHOOL: Abraham Lincoln High School Home School Northfield High School Bruce Randolph High School John F. Kennedy High School PREP Academy DSST Public Schools KIPP Public Charter Schools South High School East High School Manual High School STRIVE Prep Emily Griffith High School Martin Luther King Jr. Early College High School Thomas Jefferson High School Florence Crittenton Montbello High School West High School George Washington High School North High School INSTITUTION: Adams State University Community College of Aurora Pikes Peak Community College Aims Community College Community College of Denver Pueblo Community College Arapahoe Community College Emily Griffith Technical College Red Rocks Community College Colorado Christian University Fort Lewis College Regis University Colorado College Front Range Community College Southwest Colorado Community College Colorado Mesa University Johnson & Wales University Trinidad State Junior College Colorado Mountain College Lamar Community College University of Colorado Boulder Colorado Northwestern Community College Metropolitan State University of Denver University of Colorado - Colorado Springs Colorado School of Mines Morgan Community College University of Colorado Denver Colorado State University Naropa University University of Denver Colorado State University Northeastern Junior College University of Northern Colorado Colorado State University-Pueblo Otero Junior College Western State Colorado University Colorado Women's College Pickens Technical College MAJOR/FIELD OF STUDY: Administration Education Music Accounting Energy Nursing Art Engineering Political Science Automotive English Psychology Biology/Pre-Med Foreign Language Public Safety Business General Studies Science Communications/Journalism Health STEM Construction History Visual and Performing Arts Cosmetology Hospitality Undecided Criminal Justice Law Other Culinary Arts Liberal Arts OTHER AFFINITY GROUPS OR BACKGROUND: LGBTQ+ DACA status .
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