My Scholarship Title: ______________________________________
(Example: Annie’s Bake Shop OR Robert S. Moxy Memorial OR The Olson Family Scholarship)

Number of Scholarships _____ @ $_________ each
(There is a minimum $250 donation to name your scholarship)

Total Amount Pledged $__________

I hereby pledge and agree to pay the total sum of $_____ to the Citizens’ Scholarship Foundation of Temecula Valley for the above-named scholarships.

Signature of Donor:_______________________________________________________________________Date:________________________

Donating Organization:________________________________________________________________________________________________

Contact Person:___________________________________________________________________________Telephone#_________________

Mailing Address:______________________________________________________________________________________________________

City and Zip Code:_____________________________________________________________________________________________________

Email Address:________________________________________________________________________________________________________

Awards Presenter:_____________________________________________________________________________________________________

The Foundation would appreciate your payment returned to the address below. Please make your check payable to the Citizens’ Scholarship Foundation and

include your Scholarship Title on your check. This form needs to be completed in its entirety.

Recipient Selection Criteria
(Example: Intended major/interest; Community Service; Grade Point Average)

______________________________________________________________________________________________________________________

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_____Yes, I would like to be contacted by a Foundation member regarding the selection of my scholarship recipient.

_____ No, I would like the Foundation to select the recipient.

Please join us the evening of Monday, May 7, 2012 for a very special night presenting awards to the scholarship recipients. Share the joy with these graduating seniors and their families beginning at 6:30 at Chaparral High School in the gymnasium. Mark your calendar and plan to be a part of this wonderful evening of celebration! (Doors open at 6:00pm for seating).

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3150 Rancho Vista Road, Temecula CA 92592