Donation Form

Yes, I want to help our community by
providing a gift of $ ___________

Please check the appropriate giving level:
_____ $1,000+ Visionary
_____ $ 500+ Pacesetter
_____ $ 250+ Benefactor
_____ $ 50+ Partner
_____ $ 1+ Friend

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_____ Please contact me about establishing
my own named fund.

_____ Please contact me about making a gift
of other property (stocks, bonds, property,
life insurance, farm land, etc.)

_____ Please contact me about including the
Foundation in my will/estate plan.

PERSONAL INFORMATION

Name: _______________________________
_{As it should appear on our list of donors}

Address: _____________________________

City: ___________ State: ____ Zip: ______

Phone: _______________________________

E-mail: _______________________________

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You are encouraged to contact the Sherman County Community Foundation for updates or to discuss specific interests and individual needs. If requested, anonymity will always be honored.

_{SHERMAN COUNTY COMMUNITY FOUNDATION

813 BROADWAY, ROOM 102

P.O. BOX 888

GOODLAND, KS 67735-0888}

Inquiries: (785)821-1298

Please designate my contribution to the following fund:

_____ General Fund
          Unrestricted fund, provides flexibility so
          Foundation can respond to changing
          community needs.

_____ Affiliate Funds
          Permanent endowments of local non-profit
          organizations. (i.e. Arts Council, Library,
          Hospital, etc.)
          ___ Goodland Arts Council
          ___ Goodland Regional Medical Center
          ___ Goodland Public Library

_____ Field of Interest Funds
          Permanent endowments for identified
          program areas.
          ___ Cultural/Arts
          ___ Education/After-School Program
          ___ Health Care
          ___ Historic Preservation
          ___ Recreation
          ___ ________________________

_____ Endowments
          Named in honor of a specific person, or for an
          agency/organization. (i.e. Family Fund for
          Youth Activities, Family Fund for Seniors in
          Sherman County, Church of Choice, Etc.
          ___ Memorial Fund
          ___ Scholarship Fund
          ___ N.W. Kansas Animal Shelter
          ___ Big Brothers & Big Sisters
          ___ ________________________

_____ Pass-Through Funds
          Non-permanent funds for specific projects.
          Entire fund will be spent to complete project.
          ___ Goodland Nativity Scene Fund
          ___ __________________________
          ___ __________________________
          ___ __________________________

**THE SCCF IS A 501(C)(3) TAX-EXEMPT ORGANIZATION. CONTRIBUTIONS ARE TAX DEDUCTIBLE TO THE EXTENT ALLOWED BY LAW**