Approval Date: / / (MM/DD/YY)

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Approval Date: ______/_______/____________ (MM/DD/YY).

IMPORTANT: State law requires that contributions be completed within 60 days of the date of approval. The date of contribution is the postmark on the contribution envelope. Please allow a week for delivery.


Please mail this form, a copy of your approval letter, and check to:

GRACE Scholars, Inc.

2401 Lake Park Dr SE

Smyrna, GA 30080

I am enclosing a check for $___________ payable to GRACE Scholars, Inc. ⧠ Please keep my gift anonymous.

Name(s): Parish/City: /

E-mail Address: Telephone:

(Please indicate home/work/cell)

Home Address:

Designations. GRACE Scholars permits donors to designate scholarship funds to specific schools or to the Economically Disadvantaged Family Fund. If donors prefer, they may choose Board Choice, and the GRACE Scholars board will distribute scholarships to schools with the greatest need. Board Choice is the default selection if no designation is selected. If the scholarship needs are filled at a specified school, funds may be directed to another school with unmet need to comply with state law regarding the annual distribution of funds.

Please note: state and federal law does not permit the designation of scholarships to specific individuals or families.

You may choose up to three designations by listing the amount for each entity up to the total amount of the check:

($___________) GRACE Scholars Board Choice (250)

($___________) Economically Disadvantaged Family Fund (290)



($___________) Blessed Trinity Catholic High School (105)

($___________) Aquinas High School (301)

($___________) Christ the King School (110)

($___________) Blessed Sacrament Catholic School (375)

($___________) Holy Redeemer Regional Catholic School (115)

($___________) Immaculate Conception Catholic School (Augusta) (315)

($___________) Immaculate Heart of Mary Catholic School (Atlanta) (120)

($___________) Mount de Sales Academy (305)

($___________) Our Lady of Mercy Catholic High School (125)

($___________) Notre Dame Academy (Savannah) (380)

($___________) Our Lady of the Assumption Catholic School (130)

($___________) Sacred Heart Catholic School (320)

($___________) Our Lady of Victory Regional Catholic School (135)

($___________) St. Anne-Pacelli Catholic School (370)

($___________) Queen of Angels Regional Catholic School (140)

($___________) St. Frances Cabrini Catholic School (328)

($___________) St. Catherine of Siena Catholic School (145)

($___________) St. Francis Xavier Catholic School (330)

($___________) St. John Neumann Regional Catholic School (150)

($___________) St. James Catholic School (340)

($___________) St. John the Evangelist Catholic School (Hapeville) (155)

($___________) St. John the Evangelist Catholic School (Valdosta) (310)

($___________) St. Joseph Catholic School (Athens) (160)

($___________) St. Joseph’s Catholic School (Macon) (325)

($___________) St. Joseph Catholic School (Marietta) (165)

($___________) St. Mary on the Hill Catholic School (Augusta) (345)

($___________) St. Jude the Apostle Catholic School (170)

($___________) St. Peter Claver Catholic School (Macon) 355

($___________) St. Mary’s Catholic School (Rome) (175)

($___________) St. Peter the Apostle Catholic School (335)

($___________) St. Peter Claver Regional Catholic School (Decatur) (180)

($___________) St. Teresa’s School (365)

($___________) St. Pius X Catholic High School (185)

($___________) St. Vincent’s Academy (350)

($___________) St. Thomas More Catholic School (190)

($___________) *Other independent Catholic school


(please specify)

($___________) *Other independent Catholic school


(please specify)

*Certain independent Catholic schools may have partnered with other student scholarship organizations (SSOs). The amount designated will be forwarded to the partner SSO. Revised 11/28/2012

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