2016 MMSD EMPLOYEE
GIVING CAMPAIGN
PLEDGE FORM
DONOR INFORMATION (please print clearly)
Name
______
__________________________
Worksite (Building) ______________________________________________ Employee B#_______________
Home Address _______________________________________ City _____________ State ____ Zip ________
Personal Email Address ______________________________________________________________________
Phone Number _______________________________________________Circle One: Home/Work/Mobile
Signature ______________________________________________________________ Date ______________
 I prefer to remain anonymous. Please do not publish my name as a donor to the Foundation.
PAYMENT METHOD
Payroll Deduction
 Please deduct $_________ per month until further notice.
 Please deduct $_________ for _________ months.
One-Time Gift
Gift Amount: $_________
 Check (payable to FMPS)
 Cash
 Please charge my: Visa MasterCard American Express  Discover
Card Number: _________________________________Exp. Date: _______Security Code ____
*Online gifts are also welcome at www.fmps.org/donate (please note Employee Giving in the comments section).
USE OF MY GIFT
Please check all that apply. If you do not select a use, your gift will support the Foundation’s work throughout the
district.
 Foundation Fund:. Your donation will be directed where it is needed most.
 Foundation Endowment Fund. I would like $_____ of my gift added to the Foundation Endowment Fund,
with the income used to support annual grants developed by MMSD staff and/or students as well as
Foundation programming.
 Foundation Grants: I would like $_____ of my gift added to the amount that the Foundation awards in the
coming year for grants to special innovative programs/projects developed by MMSD staff and/or students.
 School Endowment Funds. I would like $_______ of my gift added to the endowment fund for
____________________________ School, with the interest used to support the awarding of annual grants at
this school that cannot be funded through the core district budget.
 Designated Endowment or ABC Funds. See reverse side for listing of all FMPS funds.
PLEASE CONTACT ME REGARDING:
 the transfer of stock, real estate, or other non-cash asset.
 a gift to the Foundation through my will or other deferred giving plan.
 establishing a new fund.
If you have any questions or need additional information please contact the Foundation at 608-232-7820 or visit
www.fmps.org. Thank you!
PLEASE MAKE A COPY OF THIS FORM FOR YOUR RECORDS AND RETURN THE ORIGINAL TO
YOUR BUILDING CAPTAIN OR FMPS BY MONDAY, FEBRUARY 29TH
Designated Endowment and ABC Funds
For more information about any fund listed below, visit our website www.fmps.org or call the Foundation office at 232-7820.
IMPORTANT: For employees using payroll deduction, a minimum contribution of $5 per month per fund is
required.
 Designated Endowment Funds
I would like $_______ of my gift added to one or more of the following endowment funds at the Foundation:
$_____ Barbara Ritchie Flanagan (West)
$_____ Brendan M. Scanlon Memorial Art (East)
$_____ Bruce Dahmen Memorial Scholarship (Memorial)
$_____ Carrie Macklin Ritz and Peter Ritz
$_____ Charnan Simon Author-to-School (Thoreau/Cherokee/West)
$_____ Connor J. Driscoll Memorial Scholarship (La Follette)
$_____ Don and Alice Benn Scholarship (East)
$_____ Dr. Hess Emergency Nurse
$_____ East High Booster Club
$_____ Forever Literacy Thoreau
$_____ Friends of MSCR
$_____ Gary L. Nelson Scholarship (Memorial)
$_____ Gould/Dickinson Pottery Scholarship (East)
$_____ Homeless Education
$_____ Immigrant Families
$_____ Karen Meissen Scholarship (La Follette)
$_____ Kathy Bartell Music (Memorial, Jefferson, and Muir)
$_____ Kathy Mosher Memorial Scholarship (East)
$_____ La Follette Business and Marketing Department
$_____ La Follette Printmaking Program
$_____ Lamont Public School Scholarship
$_____ Len Rush Principal Professional Development
$_____ Louis Swedarsky Scholarship (East)
$_____ Madison’s Future Teachers Scholarship
$_____ Mary J. McClellan Elementary Music
$_____ Matt Vidulich Memorial Scholarship (East)
$_____ Milton McPike Memorial Scholarship (East)
$_____ MMSD High School Athletics
$_____ MMSD Library Endowment
$_____ MMSD Social Workers Emergencies
$_____ Mohs Music
$_____ Music Endowment
$_____ Nicole Zanoni-Health
$_____ Professor Al Hovland Tennis Scholarship (East)
$_____ Reading Recovery Scholarship
$_____ Schiavoni-Sturm Scholarship (East)
$_____ School Forest
$_____ Sennett Environmental Education
$_____ Shelley Glover Athletics
$_____ Shirley Baum Student Achievement
$_____ Susan A. Hamblin Social Studies Field Trip
$_____ West Business and Marketing Department
$_____ West Visual Arts
$_____ Wozniak/Dickinson Visual Arts
Pre-Endowments – once fully funded will provide an annual income
$_____ K-12 Science Innovation
$_____ La Follette High School Booster Club
$_____ MMSD Technology Initiatives
 ABC Funds
I would like $_______ of my gift added to one or more of the following ABC funds at the Foundation:
$_____ Access to Opportunity Driver’s License
$_____ Adult Role Models in Science
$_____ Allis ALFA
$_____ Any Given Child Madison
$_____ Badger Rock Middle
$_____ Classroom Action Research Program
$_____ Dr. Edward S. Holmes Legacy Scholarship
$_____ East High Capital
$_____ East High Athletics
$_____ Falk Elementary Capital
$_____ Friends of West High School Drama
$_____ Friends of West High School Soccer
$_____ Gompers Growing Together Initiative
$_____ Grow Our Own Principals
$_____ Jefferson Middle Orchestra
$_____ La Follette High Capital
$_____ La Follette High Athletics
$_____ La Follette Class of ‘80 Scholarship
$_____ Language and Cultural Competence
$_____ Leopold Elementary
$_____ Lowell Elementary Enrichment
$_____ LVM Capital
$_____ Madison Elementary School Playgrounds
$_____ Mary Kelley Scholarship (East)
$_____ Matthew Court Memorial Music
$_____ Memorial High Athletics
$_____ Memorial High Capital
$_____ Memorial High Visual Arts Department
$_____ Midvale Grow Your World
$_____ MMSD Fine Arts
$_____ MMSD Full Service Community Schools
$_____ MMSD Planetarium
$_____ Murph & Ann Wolman Fund for Children
$_____ Neighborhood Child Health Coalition
$_____ Raising the Bar – Healthy Choices in Madison Schools
$_____ Randall School – Olive Jones Park
$_____ Reading Recovery Scholarship
$_____ Scrabble for Literacy
$_____ Shabazz High Capital
$_____ Sherman Middle
$_____ Talented & Gifted Program
$_____ Transition Education Program (TEP)
$_____ Travel to Learn
$_____ Van Hise Elementary
$_____ West High Athletics
$_____ West High Capital
$_____ West High Class of ‘61 Education
$_____ West High Community Pool
$_____ West High Tennis Court