* Required

Personal Information

Title

First Name*required

Last Name*required

Maiden Name

Street Address 1*required

Street Address 2

City*required

State*required

Zip Code*required

Preferred Email*required

Preferred Phone Number

Please check here if you would like your gift to remain anonymous.

AAA Connection

Affliation

School Family Alumni Alumni Family Friend Faculty/Staff Grandparent Business/Corporation Foundation Former Faculty/Staff

Class of:

If you have any news you'd like to share for our FIAT Magazine, please include a note below.

Gift Information

Giving Clubs Include:

Universe Club $10,000
Galaxy Club $5,000
Planetary Club $1,000
Handmaids' Club $500
Foundress Club $250
Blue & White Club $100
Anniversary Club $75

Many employers sponsor matching gift programs and will match your charitable contributions made to Ancillae-Assumpta Academy. To find out if your company will match your gift, please enter your employer's name using the

Matching Gifts On-Line Search tool. Contact Gena Anderson if you have any questions at ganderson@ancillae.org.

Please contact your employer for a matching gift form.

A matching gift will be made by my employer:

If you wish you may designate your donation towards (choose one):

Campus Improvements Religious Education Program Athletic Program Fine Arts Program Technology for Education Scholarship Endowment Curriculum Development

Specify area eg. Math, Science, etc.

Is the gift in honor/memory of someone?

Honor of Memory of

What is that person's name?

Gift Amount*required

Enter the amount you would like to contribute as a one-time or recurring donation.

Payment Options

I will be paying a charge of $ Every month for months for an overall total of $ beginning with a charge today of $

Remaining payments will take place between and with the next payment occurring on

You can cancel your subscription by emailing ganderson@ancillae.org or calling Ext. 203

Please send a confirmation email to the address below*: