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DONATION FORM

First Name

Last Name

Street Address

Apartment Number

City

State

Zip Code

E-mail address

Home Telephone:

(555-555-1234)

Amount	Quantity	Subtotal
$25.00
$50.00
$75.00
$100.00
$150.00
$200.00
	Total:

Other Amount

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Thank You for your Donation!

If you would prefer to contribute by mail, please send a check to: Youth Shelter Program of Westchester, Inc. 220 East Eighth Street Mount Vernon, NY 10550

The Youth Shelter Program of Westchester, Inc., is a 501(c)(3) organization under the federal Internal Revenue Code. A copy of our annual report is available by writing to the New York State Office of Charities Registration, Albany, NY 12231. If your employer has a matching gifts policy, please send us the appropriate form.

“The Youth Shelter Program is a better place for me…it's a place where you could get your mind right, change your behaviors and learn better coping skills to make tough decisions. And it all benefits you.”