Scholarship Donation Form

Name: ___________________________________ Grad Yr: ____________ School Graduated From:______________________

(Women include maiden name)

Occupation or Interests: _____________________________________

Spouse: __________________________________ Grad Yr: _____________School Graduated From:______________________

Present Address: ________________________________________________________

City: ______________________________ State: ___________ Zip: _______________

Here is my voluntary scholarship contribution of: $ ________

Support our youth now by printing this page and completing this form and mailing to:

LaGrange-Keystone Alumni Association
140 Loperwood Street
Lagrange, Oh. 44050