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Serving homeless adults and families and those threatened with homelessness

Please print this form.  It cannot be completed on line.

Enclosed is a gift of $___________ to support the work of Connections for the Homeless.

Name__________________________________________________________________ 

Address________________________________________________________________ 

City_______________________________State_____________Zip_________________ 

Phone________________________ Email______________________________________

Payment method:

¨ Check: payable to Connections for the Homeless
¨ Visa or MasterCard Acct #_____________________ Exp.date_____

    Signature______________________________________________ 

Contributions are tax-deductible to the extent allowed by law.

Gift is ¨ in memory of:____________________ ¨ in honor of:______________________

Please send an acknowledgement of this gift to: 

Name______________________________Address_____________________________________

City_______________________________________ State____ Zip________________
            
¨ Enclosed is a form for my company to match my gift. 
¨ Please do not list my/our name on any list of donors. 

Please mail this form with your gift to: 
Connections for the Homeless • 2010 Dewey Avenue • Evanston, IL  60201

or fax to (847) 864-6558