P.O.
Box 500835, San Diego, CA 92150 * Tel:
(858) 653.0336 *Fax/Message: (619) 374.7335 ww.iasfund.org
Please complete this form and
return it with your check:
Name of Donor(s)
____________________________________ Email _______________________________
Street
Address ________________________________ Phone (
)________________________
City _______________________________________________ State________ Zip Code _______________
Name of Scholarship Desired (if applicable) ____________________________________________________
Donation Amount
$________________________ Check # _______________ Date _____________________
Is this a newly named
scholarship?___________ Are you
supporting an existing scholarship?_____________
If yes, please indicate which
_________________________________________________________________
May we recognize your support
publicly? Yes _________ No __________