General Donation Form

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Giving to St. Francis Medical Center Foundation touches so many lives in so many ways. Each gift is important and each giver unique in the way they choose to support the community through their gift. From individuals to large corporations, the Foundation is grateful for the time, talent and resources each one brings to help in fulfilling its mission.

Name or Company *

Street Address *

City *

State *

Zip Code *

Contact Name (for Business)

Phone *

Contribution Amount *

Email *

Type of Donation *

General

Memorial

Honorarium

If memorial or honorarium, name of person remembered or honored:

Name and mailing address of person to receive memorial/ honorarium notification:

Card accompanying memorial/honorarium to read:

INTENT OF DONATION *

Non-designated

Designated

Non-designated donations allow the hospital to direct funding in areas of greatest need

If designated, please be specific re: program/service/project you would like to support:

Contributions of $1,000 or more are eligible to be engraved on the Foundation giving plaque located at the downtown campus of St. Francis Medical Center. Would you like your name included on this plaque?

Yes

No

Should you need additional information, please contact the
St. Francis Medical Center Foundation Office:
309 Jackson Street
Monroe, LA 71201
foundation@stfran.com
(318) 966-7833

Thank you for your gift. St. Francis Foundation is a 501(c)(3) non-profit organization. Your gift is tax deductible to the full extent of the law.

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