Annual Giving Form

Pickens Academy • c/o Excellence Fund • 225 Ray Bass Road • Carrollton, AL 35447

Leadership Level:

$10,000 and up... Founders Society $5,000 - $9,999... Benefactors Society $2,500 - $4,999... Cornerstone Society $1,000 - $2,499... Loyalty Society

Leadership Level Gifts will receive invitations to special events hosted in support of Pickens Academy.

$500 - $999... Trustee Circle $300 - $499... Leadership Circle $100 - $299... Century Circle Up to $100... Patrons Circle

Direct my gift:

_______ Fine Arts _______ Science _______ Technology _______ For PA to use where most needed

Grandparents:

Gift of $100 or more will have grandchildren listed along with the grandparents’ name.

Name: ___________________________________ Address: ____________________________________ City, State, Zip ________________________________ Phone: _______________________ Email: _____________________________________________________ Employer: __________________________________ Title: _________________________________________ Business Address: __________________________________________________________________________ Business Phone: _______________________ Email: ______________________________________________ Check enclosed for $ ___________________ _______ I have made plans for Pickens Academy in my estate plans.

_______ I would like to have a confidential conversation with someone from Pickens Academy about making a planned gift.

Affiliation(s) with Pickens Academy (check all that apply)

_______ Alumni (Year) _______ Current Parent _______ Faculty/Staff _______ Alumni Parent _______ Grandparent _______ Friend _______ Anonymous

Double my Gift:

My company, __________________________________ will match my gift with an additional $___________. Please enclose employer’s matching gift form. List the name(s) of the grandchild or grandchildren that you wish to have listed with your name.

Donors may qualify for more than one category or level of giving and each category and level will be listed in the annual fund report each year.