Name (of person donating) *

If you represent an organization donating, please type their name in next box

First Name

Last Name

Address *

Enter address of person or org donating

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Phone #

(###)

###

####

How will you be paying? *

Check box below.

Credit/Debit Card (click the "Donate with Card" button below)

Check (mail to KJG Scholarship, PO 55274, Indpls IN 46220)

Cash (you will be contacted by a KJG representative)