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Foundation Online Giving - Lake Land College, Mattoon Illinois
Donor Information:
*=required information
Date:
May 26, 2013
First Name:
Last Name:
Business/Organization:
and/or
*Address:
*City:
*State:
*Zip:
Country:
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antartica
Antigua and Barbuda
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas, the
Bangladesh
Barbados
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (keeling) Islands
Colombia
Comoros
Congo
Congo, the Democratic Republic
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Czechoslovakia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
France, Metropolitan (FR)
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Isla
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Indonesia, Federated States of
Iran, Islamic Republic of
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kingman Reef
Kiribati
Korea, Democratic People's Rep
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republ
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, Former Yugoslav Rep
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinque
Mauritania
Mauritius
Mayotte
Mexico
Moldova, Republic of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar (burma)
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory,Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
S Georgia & S Sandwich Islands
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
St Vincent and the Grenadines
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistran
Turks and Caicos Islands
Tuvalu
U.S. Minor Outlying Islands
USSR (UN in Federal Code)
Uganda
Ukraine
United Arab Emirates
United Kingdom (great Britain)
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City State, See Holy S
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis And Futuna
Western Sahara
Yemen, Aka Democratic Yemen
Zambia
Zimbabwe
*Contact Phone:
Contact Email:
(
)
-
Email address will be used for sending a confirmation email
My billing name and/or address is the same as above
My billing name and/or address is different than above
Billing Information
First Name:
Last Name:
Business/Organization:
and/or
*Address:
*City:
*State:
*Zip:
*Contact Phone:
(
)
-
Gifts of any amount are welcome
Donor History:
First-time Donor
Returning Donor
*Gift Amount:
Frequency:
Weekly
Monthly
I pledge the following amount to be charged to my credit card on the frequency basis selected:
$100
$75
$50
$25
Other(please indicate amount below)
Other Amount: $
Please use my gift:
Where the Need is the Greatest
To renew my scholarship(s)
To establish a new scholarship(s)
LLC Alumni Association Endowment
Student Emergency Assistance Fund
Other
If you wish your gift to be used other than the options listed above, please enter in the comment box below how you would like it to be used.
I wish to have my gift distributed to:
1 Student
2 Students
Other (please specify)
I wish my scholarship to be named/renamed:
I wish the following criteria be placed on my scholarship:
I wish to have my gift distributed to:
1 Student
2 Students
Other (please specify)
I wish my scholarship to be named:
I wish the following criteria be placed on my scholarship:
Scholarship information is listed in college and foundation publications and other publicity materials unless requested below.
I do not wish to have any publicity regarding my donation to Lake Land College Foundation.
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Sustainability at LLC
5001 Lake Land Blvd.
Mattoon, IL 61938-9366
217-234-LAKE
