Chiesman Foundation for Democracy

DONATIONS

The Chiesman Foundation For Democracy is a nonprofit educational organization as described in section 501 (c) (3) of the Internal Revenue Code. Donors may deduct contributions to one of the projects of the foundation as provided in section 170 of the code. No donated or sponsorship funds are used to defray the Foundation's administrative costs.

With your contribution we can continue to support the Chiesman Foundation projects:

Enclosed is my gift of ...
[___] $35	[___] $50	[___] $75	[___] $100	[___] $250	[___] Other $__________

Select one of the following projects and make check payable to selected project name:
	Communities Empowering Youth, Organizational Capacity Building Grant
	Center For Civic Participation & Leadership (CCPL)
	Institute for Educational Leadership & Evaluation (IELE)
	Kids Voting South Dakota (KVSD)
	South Dakota Issues Forums (SDIF)
	Institute for South Dakota Leadership & Participation (SDLP)
	South Dakota Public Policy Institute (SDPPI)
	Safe Kids Project (SKP)
	Rapid City Character Counts Coalition (CC)

Contact Information:

Name:

Organization:

Address:

City:

State:

Zip Code:

Country:

Email:

Telephone:

[___]	Yes, I would like to receive an annual subscription to the Chiesman Quarterly, which reports on the progress of different projects plus articles on democracy.

[___]	Yes, I would like my name on the Chiesman Foundation For Democracy website listed as a Supporter to the Foundation.

To make a donation by mail, please print this form and mail it with your check to:

Chiesman Foundation For Democracy, Inc.
1641 Deadwood Ave.
Rapid City, SD 57702

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