Donation form SECTION I: DONOR INFORMATION Name (required): Significant Other Name: Mailing Address: City: State: Zip: Daytime Phone: WorkHome Evening Phone: WorkHome Email (required): Are you an Alumn?YesNo If yes, what year(s) did you attend and what discipline(s) did you study? SECTION II: GIFT DESIGNATION Greatest Area of Need $ Student Financial Aid $ HSA Prep Fund $ Educational Outreach $ Facilities Fund $ TOTAL: $ SECTION III: PAYMENT INFORMATION I have enclosed a check or money order payable to Harlem School of the Arts. Please charge my contribution to my (check one): Credit Card Type VisaAMEXMastercardDiscover Card # Cardholder Name Exp. Date CVV Billing Address City State Zip I would like to pledge my commitment to HSA for a total of $ Please remind me each: MonthQuarterOther I would like to honor my pledge commitment in a single payment on. Please send me a pledge reminder prior to that date. SECTION IV: SPECIAL INSTRUCTIONS I work/my significant other works for a Matching Gift Company. Form available through your employer. Company Name: This gift is (circle one): In honor ofIn memory of Name: Please notify: Mailing Address: City: State: Zip: Additional Comments: I certify that the information submitted in this application is true and correct to the best of my knowledge. (required) Your donation is fully tax deductible. Thank you for your support! More About UsMission Statement HSA At A Glance History of HSA Board of Directors Staff & Administration Associate Board HSA Alumni Annual Report Employment Opportunities Support Harlem School of the Arts Today!