Giving D39C Collaborative Annual Giving Campaign GENERAL FUND CONTRIBUTIONS ($500/student general fund contribution suggested) Number of Design39Campus students: * Donation amount per student: 500.00 350.00 200.00 Other CLASSROOM CONTRIBUTIONS ($39/student voluntary classroom contribution suggested) Student 1 Grade Level TK K 1 2 3 4 5 6 7 8 Student 1 - Classroom Contribution 0.00 39.00 Other Student 2 Grade Level TK K 1 2 3 4 5 6 7 8 Student 2 - Classroom Contribution 0.00 39.00 Other Student 3 Grade Level TK K 1 2 3 4 5 6 7 8 Student 3 - Classroom Contribution 0.00 39.00 Other Student 4 Grade Level TK K 1 2 3 4 5 6 7 8 Student 4 - Classroom Contribution 0.00 39.00 Other Student 5 Grade Level TK K 1 2 3 4 5 6 7 8 Student 5 - Classroom Contribution 0.00 39.00 Other CONTRIBUTION SUMMARY (Combination of General Fund Contribution and Classroom Contributions) Full Payment OR 4-Equal Monthly Payments * Full Payment 4-Equal Monthly Payments Please accept our TOTAL DONATION AMOUNT of: Your 4-EQUAL MONTHLY PAYMENT AMOUNTS will be: Parent/Guardian First Name Last Name Email Address * Primary Phone Number Parent /Guardian First Name Last Name Email Address Primary Phone Number Address Street City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Postal Code Employer Matching Does your employer match charitable contributions? Yes No If “Yes,” please file the appropriate paperwork with your matching program administrator. They will then contact The D39C Collaborative! Click the 'Double The Donation' image to the right to get more information. Employer Name May we publicly acknowledge your family’s last name(s) on our annual donor recognition feature? Yes No * Cutoff for inclusion on our annual donor recognition statue is March 1, 2017. If so, please indicate your family's last name preference for our annual donor recognition feature. Please click in the reCAPTCHA checkbox next to 'I'm not a robot'. You may be asked to select 1 or 2 pictures to confirm you are a real person and not an electronic program.