Editing previous response:

Please fix the highlighted areas below before submitting.

Donate to SEGULA

We need your suport! It costs approximately $30,000 to educate a SEGULA child. Your gift can immeasurably impact the lives of SEGULA children by providing an opportunity for students with special needs to experience a day school environment.

Please complete the form below. Required fields marked with an asterisk *

CONTACT INFORMATION

First Name*

Answer required for "First Name"

Middle Initial

Answer required for "Middle Initial"

Last Name*

Answer required for "Last Name"

ADDRESS

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Email Address*

Answer required for "Email Address"

Phone Number*

Answer required for "Phone Number"

Amount*

Answer required for "Amount"

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"