You truly represent one of literacy's most valuable assets. We believe the best way to tell a story is first-hand... and by someone involved. We would like to relate your "story" so that others may follow your path in giving the gift of literacy.

This information sheet is provided to elicit as much (or as little) information as you are comfortable sharing. The purpose of this form and this information is to provide accurate data for your voluntary participation in a controlled publication/release by ProLiteracy Worldwide.

No personal contact data such as phone numbers or addresses will be released.

Why is literacy so important to you?

Name:

City:

State:

E-mail address:

Place of Birth:

Your education/training:

Occupation(s):

Favorite activities/interests:

Travels:

Literacy related activities (volunteer &/or professional):

What motivated you to make your gift(s) to ProLiteracy?

Any other information you feel would be helpful in an article designed to encourage readers to consider a planned gift like yours:

Authorization:
I give permission to ProLiteracy Worldwide to use my name, photos and these data for the limited and express purposes of promoting and publicizing support for its charitable programs in its communications with donors and prospective donors. No release of this information to third parties for their subsequent use or benefit is authorized.

 
By submitting this form, you indicate your
agreement to the above Authorization statement.