You can contribute by simply clicking on the graphic above or by filling out the form below. However you give, you will help kids reclaim their lives.

Here are some of our supporters you will be joining in this cause.

In order to help the community’s at-risk kids, please print out this document (or download it in PDF format, requires Adobe Acrobat Reader®, download Acrobat Reader® here) and return the completed form to:

The Center for Success and Independence
3722 Pinemont Drive
Houston TX 77018

Contribution Form

Please complete the following form, print and sign and date it and return this form along with your payment to the address listed above.

Donor’s Name:

Mailing Address:

City: State: Please Select: Alabama Alaska Arizona Arkansas California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Zip:  

Email Address:

Daytime Phone: Fax:

Gifts in Tribute

I would like to make my gift in honor of or in memory of:

Please notify:

Payment:

I would like to make a tax deductible contribution in the amount of

Check Enclosed:
(Please make your check payable to The Center for Success and Independence)

Credit Card Number:

Credit Card: Please Select Card American Express Master Card Visa Discover

Expiration Date: 1 2 3 4 5 6 7 8 9 10 11 12 2005 2006 2007 2008 2009

Name as it appears on card:

Signature: ____________________ Date: ____________

100% of your donation is tax deductible.

Thank you for helping us change lives and build futures!