DONATION FORM

We rely on funding from Corporations, Individuals, and Foundations to support our programs.

Please make your donation today by filling out this form. We are a 501(c) (3) charity organization, which means your donation is tax deductible from Internal Revenue Service (IRS)

Federal Identification Number: 04- 3728123 NYS Charity Registration Number: 21- 12- 68

Title
First Name:*	Enter your first name.
Last Name:*	Enter your last name.
Address:*	A valid address is required.
Address2:
City:*	Enter your City.	State:
Country:*	Enter your country.	Zip Code:
Home Phone:		Mobile:
Email:*	A valid email address is required.	Fax:
Amount for Donation (Format for "other" amount does not include dollar signs, commas, or decimal points.)	$10 $20 $40 $80 Other	Comments	Add comments here
	() Are Required Fields*