Transitional Services of New York, for Long Island, Inc.
Haven House/.Bridges, Inc.

Donation Form

Instructions:  Print out this page, fill in the information requested, and mail along with your check to:

TSLI/HHB
840 Suffolk Avenue
Brentwood, NY 11717
att: Lori Meyers

Please make checks or money orders out to either: "TSLI, Inc." or "HHB, Inc."

Thank you for your generosity! You will receive written confirmation of your donation by mail. TSLI, Inc. and HHB, Inc. are both 501 (c)3 tax exempt organizations. Donations are tax deductible.

Name: ________________________________    Date:__________________

Address:_______________________________________________________
                street                                            town                        state, zip code

E-mail:_________________________    Phone:(         ) ____________________

I would like to help out the programs of TSLI and HHB through my contribution of:

$1000 Benefactor

$500 Sponsor

$250 Supporter

$100 Friend

$50 Contributor

$25 Member

$_____ Other

I would like my contribution to support:

	Whichever program(s) need my help		Summer Camp Fund ( send a child to camp)
	Progam(s) serving the Mentally Ill		School Supplies Fund
	Program(s) serving homeless families		Holiday gifts fund for homeless adults
	Program(s) serving persons with HIV/AIDS		Holiday gift fund for mentally ill adults