Cheverus -- Office of Institutional Advancement -- Online Giving

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Online Donation Form

First Name:

Middle Name:

Last Name:

Home Address Line 1:

Home Address Line 2:

City:

State:

Zip:

This is a new address: Yes No

Home Phone:

E-Mail:

CHS Affiliation (Please check all items that apply.)

Alumnus:	Class of:
Current Parent:	Class of:
Past Parent:
Grandparent:
Faculty / Staff:
Friend:

Cheverus Donor Societies
	Ignatian Circle	$2,500 +
	President's Circle	$1,000 - 2,499
	Visionaries' Circle	$500 - 999
	1917 Club	$250 - 499
	Century Club	$100 - 249
	Friend's Club	$10 - 99

Please enter an amount you would like to contribute: $

Select Donation Type
	Pledge
	Gift

Select Donation Designation
	Challenge Drive (Annual Fund)
	Capital Campaign

Please send notification to:

The address above:

OR

Name:

Address Line 1:

Address Line 2:

City:

State:

Zip:

I wish this gift to remain anonymous