Mitchell High School

Mitchell Community Scholarship Fund

Pledge Form

I/We wish to help a student by making a pledge of $__________.

I/We will fulfill this pledge:
_____by enclosing full playment.
_____by paying in full in __________.(month/year)
_____by paying over time beginning __________(month/year) and ending __________(month/year).

For recognition purposes:

For donations of $250 or more, please name the scholarship(s) as follows:
_____________________________________________________________

Please name the scholarship in honor of/in memory of:
______________________________________________________________

_____ I/We wish to remain anonymous.

______________________________________________________________

Donor(s') Name(s)

______________________________________________________________

Address

______________________________________________________________

City/State/Zip

______________________________________________________________

Signature

______________________________________________________________

Date

_____ Please contact me wit details about other ways to give: credit card, stocks, securities, annuities, estates, ect.

Please complete this form and send to:

Mitchell Community Scholarship Fund
PO Box 1087
Mitchell, South Dakota 57301

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