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Selwyn House
Online Donations
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Donor Information
* = required
Full Name *
Affiliation *
Year of Graduation     (4 digits, if applicable)
Street Address *
City *
Province/State *
Postal/Zip Code *
Daytime Telephone *
Email *
Please indicate how you would like your name(s) to be recognized in our Donor Listings
I wish for my name to remain anonymous
Credit Card Information
I wish to pledge/contribute:
Amount (Cdn$) *
Please debit my credit card *
Monthly         with payment/installments of   (Amount $Cdn)
One-time Gift  
Please keep my credit card details on file for any installment payments
Credit Card Type *
Credit Card Number *
Expiration Date *   *
Name on Card *
Directed Donations
* I would like this gift to be directed to:
$ Campaign for Selwyn House School (SHS AREA OF GREATEST NEED)
$ Annual Giving
$ Old Boys' Endowment Fund
$ William Mitchell Endowment Fund
$ Conrad H. Harrington Scholarship Fund
$ Nancy Pitfield Scholarship Fund
$ David Pitblado '78 Endowment Fund
$ Gaelan O’Donnell '83 Endowment Fund
$ Colin No '97 Endowment Fund
$ Aditya Pathak 2005 Endowment Fund
$ Pledge Payments (If you have an existing pledge, payments can be made here.)
NOTE: It is important to maintain our Annual Giving, which supports special needs and program enhancements at the school. "One gift, two targets". We will designate 80% of your donation to the chosen Endowment Fund and 20% to Annual Giving unless you specify otherwise in the special instructions box below.

  I would like more information about leaving a gift to Selwyn House School in my will.


Matching Gifts?
Please indicate whether your employer or your spouse's employer will match your gift.
  Yours | Spouse | Organization Name(s)
Yes, matching form will be sent later
No, matching not available  
Please fax your form to James McMillan at 514-931-7152 or mail to him in care of the Advancement Office, Selwyn House School, 95 ch. Cote St. Antoine, Westmount, QC H3Y 2H8

In Honour / Memory of
I would like this gift to be in Honour / Memory of:
      In Honour   In Memory
  Please send an acknowledgement of my gift to:
Special Instructions
Any special instructions we should know?

Thank You! Your receipt will be emailed to the above address.

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