Contribution Form Please mail this form with a copy of your approval letter from the Dept of Revenue to



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Contribution Form

Please mail this form with a copy of your approval letter from the Dept. of Revenue to:

GRACE Scholars, Inc. Approval Date: _____/______/____________

2401 Lake Park Dr SE

Smyrna, GA 30080

Name: Parish/City: /

E-mail Address: Telephone: ___________________ (Please Indicate: Home/Work/Cell)

Home Address:

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

GRACE Scholars, Inc. permits donors to designate scholarship funds to the Economically Disadvantaged Family Fund or to specific schools. If the donor prefers, 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 in order 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)

Schools of the Archdiocese of Atlanta
Schools of the Diocese of Savannah

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

($___________) Aquinas Catholic High School (301)

($___________) Christ the King Catholic School (110)

($___________) Blessed Sacrament Catholic School (375)

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

($___________) Immaculate Conception Catholic School (315)

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

($___________) Mount de Sales Academy (305)

($___________) Our Lady of Mercy Catholic H. S. (125)

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

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

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

($___________) Sacred Heart Catholic School (320)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

($___________) St. Mary Catholic School (175)

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

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

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

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

($___________) St. Teresa Catholic School (365)

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

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

($___________) Other independent Catholic School*

($___________) Other independent Catholic School*

____________________________

___________________________

* Certain independent Catholic schools may have partnered with other Student Scholarship Organizations (SSO). The amount designated will be forwarded to their partner SSO with the form.


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