Donation Receipt Request Form Please print School: Purpose of Donation: Donation Amount: Date: Payment Method: (circle one)

Cash

Cheque

Online Receipt #:

Donor Name: Donor Address: Street City, Province Postal Code Student Name: (if applicable) Please note: ineligible or incomplete forms will not be processed Information collected on this form is collected under the authority of the Income Tax Act. Information will be used to issue charitable donation receipts, for legislative compliance and administration. For additional information, please contact the Manager of Accounting at [email protected] or for privacy specific questions, please contact the Records Manager at [email protected].

Donor Signature

For Office Use: Donation Received By Deposit Reference Number