Xavier Foundation Donation Form - Gift by Mail
The gift of a Xavier Catholic education would not be possible without your support. 

Please print this form, complete the information and then send it with your contribution to:
The Xavier Foundation, P.O. Box 10956, Cedar Rapids, IA  52410-0956.

Honor Clubs

Founders $100,000 and above
Benefactors $50,000 - $99,999
Trustees $25,000 - $49,999
Directors $10,000 - $24,999

Crusaders:

$5,000 -$9,999

Commanders: 

$2,000 - $4,999

Leaders:   

$1,000 - $1,999

Challengers:  

$500 - $999

Builders: 

$250 - $499

Sustainers: 

$100 - $249

Friends: 

$99 and below

My gift is enclosed - Gift Amount:   $ ___________

I authorize the Xavier High School Foundation to charge $ ___________ 

_____ Mastercard                         _____ Visa

Name as it appears on card:_________________________________________________

Expiration date:__________________________

Account number: __________________________________________________________
(if you prefer not to mail your credit card account number, you may call the Xavier Foundation office at 378-4571 and provide this information by telephone.)

Apply my contribution to:  
____ Annual Fund  ( ____ Parish Appeal  ____ Alumni Appeal  ____ Business Appeal)
____ Scholarship Endowment Fund 
____ Memorial/Honorarium Program   
In memory of _________________________ In honor of ___________________________

____  Send me information about how I can create a legacy with a planned or deferred gift,  
or contact Jody Ruff at (319) 378-4571 or jruff@xavierfoundation.org.

Full Name  ________________________________ Spouse Name  _________________________________
Address __________________________________ City  ____________________ State ____  Zip ________
Phone  ___________________________________ Email  ________________________________________ 
Employer Name  ___________________________  Employer Match: Yes ____  No ____ 

High School Graduate of:  LaSalle ____ Regis ____  Xavier ____   Class Year ________

Parish (for Cedar Rapids/Marion metro area residents only) ________________________________ 

Signature:  _______________________________________