Extend Your Heart                                                                                              
                                               EIN#: 01-0615288                                                                                              

                                                                                      Donation Form                                                                           

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Contact Information
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* Last Name:
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EXTEND YOUR HEART PROGRAMS DONATION AMOUNTS                    
Education Sponsorship
($100 can help a child go to school a year)
$ for student(s)
1. 3.
2. 4.
Hoang Lan School of Love
(25 cents can provide a child a meal)
($50 supports one month salary of a teacher)
$
Bicycles
($50 can help a child to have a bike going to school)
$
One Time Donation
$
Administrative Fund
$
Total
$

My gift is In Honor or In Memory of someone
Please check the appropriate box below and enter additional information on the comment box.
My donation is In Honor of someone.
My donation is In Memory of someone.

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Extend Your Heart | 3677 Tully Court, San Jose, CA  95148 | 408-218-1476
extendyourheart@yahoo.com
www.extendyourheart.org

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