IMPACT SCHOLARSHIPS Letter of Intent

DONOR INFORMATION

Name(s)
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Class Year or Affiliation
Donor Phone (H) Donor Phone (H) - ### - ### ####
Donor Phone (C) Donor Phone (C) - ### - ### ####
Donor Phone (O) Donor Phone (O) - ### - ### ####
Donor Email
SCHOLARSHIP INFORMATION
Name of Scholarship
Designation

Note: Donors are able to choose one designation based on a student’s home region, academic interest, extracurricular activity, or career interest
I do not wish to designate my scholarship. I wish to make my gift anonymously.
STEWARDSHIP INFORMATION
Use “Donor Information” above for all student correspondences and event invitations. Send correspondences to:
Name(s)
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Stewardship Class Year or Affiliation
Stewardship Phone (H) Stewardship Phone (H) - ### - ### ####
Stewardship Phone (C) Stewardship Phone (C) - ### - ### ####
Stewardship Phone (O) Stewardship Phone (O) - ### - ### ####
Stewardship Email
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