I would like to help local students through the Barnes County North
Dollars for Scholars Chapter
Name/Business: _______________________________________________
Address: _____________________________________________________
City/State: _____________________________________________________
Phone: ______________________________________________________
Email: _____________________________________________________
________ Unrestricted - Will be used to fund scholarships and operating expenses
________ Endowment Fund - Interest earned will provide scholarships
________ Named Scholarship - Given in the name of __________________________________________________________
________ Memorial or Honor Gift - Your gift provided in memory or honor of the person (s) listed below
In memory of _____________________________________________________________________
In honor of _____________________________________________________________________
Tax deductible contributions are payable to:
Barnes County North Dollar for Scholars
9966 21st St. SE
Wimbledon, ND 58492