Scholarship Registration ! Thank you for providing a scholarship for a student-mentor-prayer partner relationship through . Your ongoing, monthly support will help a young life change. Your InformationTitle*Mr.Mrs.Ms.Dr.Rev.Name* First Last CompanyEmail* PhoneScholarship Donation DetailsYour donation to sponsor a Kids Hope USA relationship is an annual commitment of $180. You may choose to set up one annual recurring donation or spread it out into 12 recurring monthly donations of $15. The quantity below is the number of Kids Hope USA relationships (mentor, prayer partner and student) you wish to scholarship. Thank you for your commitment to reach more kids better! Recurring Donation Frequency*Please select oneMonthly ($15/mo)Annual ($180/yr)Life Together Scholarship (monthly donation)* Price: $15.00 Quantity: QUANTITY indicates the NUMBER of mentors you will be sponsoring.Life Together Scholarship (annual donation)* Price: $180.00 Quantity: QUANTITY indicates the NUMBER of mentors you will be sponsoring.Total Charge $0.00 I would like to supportDISCLAIMER: The program director will assign your scholarship, if possible. When all relationships for this church receive scholarships, additional scholarships received will support other students where needed. I prefer that this scholarship remain anonymous Payment DetailsCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I Authorize Kids Hope USA to process my donation as a monthly or annual recurring charge to my debit or credit card . You may cancel at anytime. You can access your account at https://programs.kidshopeusa.org. If you need help logging in, contact our Technical Support Center at email@example.com or (800) 888-5991.