ASHFoundation Individual Donor Form

<!DOCTYPE html> <html> <head> <meta http-equiv="Content-Type" content="text/html; charset=UTF-8" /> <meta charset="utf-8" /><meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1"><meta name="format-detection" content="telephone=no"><meta name="IE_RM_OFF" content="true"><meta name="viewport" content="width=device-width, initial-scale=1.0" /> <title>ASHFoundation Individual Donor Form</title><meta name="description" content="Join the thousands who donate to the ASHFoundation every year. Your gift empowers promising innovators to pursue bold, forward-thinking solutions in communication sciences and disorders." />  <meta name="robots" content="index,follow" /> <meta name="DC.publisher" content="American Speech-Language-Hearing Foundation" /> <meta name="DC.rights" content="Copyright American Speech-Language-Hearing Foundation" /> <meta name="og:description" content="Join the thousands who donate to the ASHFoundation every year. Your gift empowers promising innovators to pursue bold, forward-thinking solutions in communication sciences and disorders." /> <meta name="og:site_name" content="American Speech-Language-Hearing Foundation" /> <meta name="og:title" content="ASHFoundation Individual Donor Form" /> <meta name="og:type" content="website" /> <meta name="og:url" content="https://www.ashfoundation.org/ways-to-give/individual-donor-form/" /> <meta name="twitter:description" content="Join the thousands who donate to the ASHFoundation every year. Your gift empowers promising innovators to pursue bold, forward-thinking solutions in communication sciences and disorders." /> <meta name="twitter:title" content="ASHFoundation Individual Donor Form" /> <link rel="apple-touch-icon" sizes="180x180" href="/Static/themes/foundation/favicons/apple-touch-icon.png" /> <link rel="icon" type="image/png" sizes="32x32" href="/Static/themes/foundation/favicons/favicon-32x32.png" /> <link rel="icon" type="image/png" sizes="16x16" href="/Static/themes/foundation/favicons/favicon-16x16.png" /> <link rel="manifest" href="/Static/themes/foundation/favicons/manifest.json" crossorigin="use-credentials" /> <link rel="mask-icon" href="/Static/themes/foundation/favicons/safari-pinned-tab.svg" color="#5bbad5" /> <meta name="theme-color" content="#ffffff" /> <link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/font-awesome/4.4.0/css/font-awesome.min.css"> <link rel="stylesheet" href="https://cdn.jsdelivr.net/jquery.slick/1.6.0/slick.css"> <script src="https://ajax.googleapis.com/ajax/libs/jquery/2.2.4/jquery.min.js"></script> <link href="https://www.ashfoundation.org/ways-to-give/individual-donor-form/" rel="canonical" /> <link href="/bundles/foundation/css?v=8VmYmAL2VR1W-_umtsSQt5PM84zvJ6J8hpyPNp9oJ4M1" rel="stylesheet"/>  <script src="https://use.typekit.net/jmt8dth.js"></script> <script>try { Typekit.load({ async: true }); } catch (e) { }</script>  <script> (function (w, d, s, l, i) { w[l] = w[l] || []; w[l].push({ 'gtm.start': new Date().getTime(), event: 'gtm.js' }); var f = d.getElementsByTagName(s)[0], j = d.createElement(s), dl = l != 'dataLayer' ? '&l=' + l : ''; j.async = true; j.src = 'https://www.googletagmanager.com/gtm.js?id=' + i + dl; f.parentNode.insertBefore(j, f); })(window, document, 'script', 'dataLayer', 'GTM-K2DJNCT');</script>  <script type="text/javascript">var appInsights=window.appInsights||function(config){function t(config){i[config]=function(){var t=arguments;i.queue.push(function(){i[config].apply(i,t)})}}var i={config:config},u=document,e=window,o="script",s="AuthenticatedUserContext",h="start",c="stop",l="Track",a=l+"Event",v=l+"Page",r,f;setTimeout(function(){var t=u.createElement(o);t.src=config.url||"https://az416426.vo.msecnd.net/scripts/a/ai.0.js";u.getElementsByTagName(o)[0].parentNode.appendChild(t)});try{i.cookie=u.cookie}catch(y){}for(i.queue=[],r=["Event","Exception","Metric","PageView","Trace","Dependency"];r.length;)t("track"+r.pop());return t("set"+s),t("clear"+s),t(h+a),t(c+a),t(h+v),t(c+v),t("flush"),config.disableExceptionTracking||(r="onerror",t("_"+r),f=e[r],e[r]=function(config,t,u,e,o){var s=f&&f(config,t,u,e,o);return s!==!0&&i["_"+r](config,t,u,e,o),s}),i}({instrumentationKey:"d6383f77-0ec7-4108-887c-7a90b8f93232",sdkExtension:"a"});window.appInsights=appInsights;appInsights.queue&&appInsights.queue.length===0&&appInsights.trackPageView();</script></head> <body id="home" class="home-template"> <form>  <noscript> <span class="alert alert-danger" role="alert"> You do not have JavaScript Enabled on this browser. Please enable it in order to use the full functionality of our website. </span> </noscript>  <noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-K2DJNCT" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>  <noindex>  <header id="header"> <div class="container"> <div class="col-xs-12 col-md-4"> <a href="/" class="logo-svg" title="American Speech-Language-Hearing Foundation"> <svg version="1.1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" x="0px" y="0px" viewBox="0 0 86 134" style="enable-background:new 0 0 86 134;" xml:space="preserve"> <rect x="1.5" y="1.3" style="fill:#FFFFFF;" width="8.7" height="71.1" ></rect> <rect x="75.8" y="1.2" style="fill:#FFFFFF;" width="8.7" height="43" ></rect> <rect x="13.6" y="1.2" style="fill:#FFFFFF;" width="11.3" height="99.1" ></rect> <rect x="60.9" y="1.3" style="fill:#FFFFFF;" width="11.3" height="69.3" ></rect> <path style="fill:#FFFFFF;" d="M44.9,130.4c1.8-10.2,3.6-19.7,5.2-30.5c0-0.2,4.8,1.8,7,2.7V1.2H28.2v131.6h28.9v-23.7 c-1.1,5.6-2.9,14.3-5,23.4C52,132.7,46.1,130.8,44.9,130.4z M29.6,107.7c-0.5-9.2,3.3-17.6,9.9-23.8c0.2-0.2-7.4-7.3-7.8-16.8 c-0.6-12.7,9-20.2,9.2-20.4c6.4-7.3,6.7-18.5,6.9-18.3c2.9,4.4,3.5,6.1,5,9.3c1.3,2.7,2.6,6.1,1.6,9.2c-0.8,2.5-3.9,5.9-7.3,10.1 c-2.9,3.6-5.7,4.7-6,20.1c0,0.1,3.3-4.4,4.1-5.7c1.3-2.1,3.5-3.3,5.4-4.7c3.6-2.7,4.5-8.6,4.7-8.8c1.1,3.1,0.8,7.8-1.6,15.1 c-0.1,0.3-3.8,10.3-11.8,11.8c-0.2,2.6,2.3,7.2,2.2,7.4c-0.7,2-1,2.6-1.7,4.3c-1.3,3.5-2.3,6.8-3.4,10.4c-1.4,4.7-3.1,9.6-4.4,14.4 C34.4,121.5,30.1,116.4,29.6,107.7z M36.6,124.3c1.2-3.5,8.3-25.6,9.3-28.6c0.5,0.5,0.9,1,1.5,1.6c-2.3,10.4-3.4,20.6-5.5,31.4 C41.9,128.9,38.5,126,36.6,124.3z" ></path> </svg> <div class="text"> American <br class="hidden-xs" />Speech-Language-Hearing <br class="hidden-xs" /><strong>FOUNDATION</strong> </div> </a> </div> <div id="mobile-nav-wrap"> <div class="col-xs-12 hidden-md hidden-lg"> <button id="hamburger" type="button" data-toggle="dropdown" data-target="#mobile-nav-wrap" aria-haspopup="true" aria-expanded="false"><span class="hamburger"></span></button> </div> <div id="mobile-nav"> <div class="col-xs-12 col-md-6">  <nav id="main-nav" class="main-nav"> <ul class="nav nav-justified no-margin"> <li><a href="/">Home</a></li> <li><a href="/our-work/">Our Work</a></li> <li class="menu-item-has-children"> <a href="/apply/">Apply <span class="caret"></span></a> <div class="dropdown-nav"> <div class="row"> <div class="col-md-4"> <h4 class="text-white text-uppercase no-margin-t">Research Grants</h4> <a href="/apply/#Grants">Students & Researchers</a> </div> <div class="col-md-4"> <h4 class="text-white text-uppercase no-margin-t">Student Scholarships</h4> <a href="/apply/#Scholarships">Students</a> </div> <div class="col-md-4"> <h4 class="text-white text-uppercase no-margin-t">Clinical Achievement Awards</h4> <a href="/apply/#Awards">Nominations</a> </div> </div> </div> </li> <li><a href="/ways-to-give/">Ways to Give</a></li> </ul> </nav> </div> <div class="search-wrap col-xs-12 col-md-2">  <div class="search-open"> <div id="search-form"> <div class="field-wrap"> <i class="fa fa-search" aria-hidden="true"></i> <label class="sr-only" for="textfield">Type your search query here</label> <input type="search" class="form-control no-border-radius" name="q" placeholder="Search" id="textfield" alt="Search ASHA Foundation" onfocus="SearchFocused();" onblur="SearchBlurred();" title="Search ASHA Foundation Textbox"> </div> <button class="sr-only" type="button" id="searchButton" title="Search" name="searchButton" onclick="return SearchClick();"></button> </div> <script type="text/javascript"> var searchBoxHasFocus = false; $(document).ready(function () { $(".close-search").click(function(){ $('.nav-item a').fadeToggle(300); }); $("#textfield").on("keypress", function (e) { var keycode = (event.keyCode ? event.keyCode : event.which); if (keycode == '13') { $("#searchButton").click(); return false; } }); $("#searchTextModal").on("keypress", function (e) { var keycode = (event.keyCode ? event.keyCode : event.which); if (keycode == '13') { $("#searchButtonModal").click(); return false; } }); }); function SearchClickModal() { var textfield = document.getElementById('searchTextModal'); var searchUrl = ReadSearchUrlFromConfig(); if (trim(textfield.value).length > 0) { window.location = searchUrl + HandleSpecialCharacters(textfield.value); return false; } else { textfield.value = ""; textfield.select(); return false; } } function SearchClick() { var textfield = document.getElementById('textfield'); var searchUrl = ReadSearchUrlFromConfig(); if (trim(textfield.value).length > 0) { window.location = searchUrl + HandleSpecialCharacters(textfield.value); return false; } else { textfield.value = ""; textfield.select(); return false; } } // Replace ampersands function HandleAmpersand(value) { return value.replace(/&/g, "%26"); } //replace plus sign function HandlePlusSign(value) { return value.replace(/\+/g, "%2B"); } function HandleSpecialCharacters(value) { var val = HandleAmpersand(value); val = HandlePlusSign(val); return val; } function ReadSearchUrlFromConfig() { var searchUrl = 'https://find.asha.org/ashfoundation#q='; return searchUrl } // Removes leading whitespaces function LTrim(value) { var re = /\s*((\S+\s*)*)/; return value.replace(re, "$1"); } // Removes ending whitespaces function RTrim(value) { var re = /((\s*\S+)*)\s*/; return value.replace(re, "$1"); } // Removes leading and ending whitespaces function trim(value) { return LTrim(RTrim(value)); } function SearchFocused() { searchBoxHasFocus = true; } function SearchBlurred() { searchBoxHasFocus = false; } </script></div> <script> $('.navbar-nav .search').click(function () { $('.navbar-nav > li > a').fadeToggle(300); $('.search-open').fadeToggle(300); $('.search-open').toggleClass('expanded'); });</script> <a href="/Ways-to-Give/Individual-Donor-Form/" class="btn btn-lg">Donate Now</a> </div> </div> </div> </div> </header> </noindex> <div class="content"> <div class="container"> <h1 class="page-header" >Individual Donor Form</h1> <div class="span8 clearfix" > <p>Join the thousands who donate to the ASHFoundation every year. Your gift empowers promising innovators to pursue bold, forward-thinking solutions in communication sciences and disorders.</p> <p><strong>If your donation is in honor or in memory of someone, please <a href="/ways-to-give/honor-or-memorial-donation-form/">donate here</a>.</strong></p> <p><strong>ATTENTION DONORS OUTSIDE THE UNITED STATES: </strong>Our credit card processing tool prepopulates the “Country” field to United States. If you are making a gift from a country outside of the US, please leave the "Country" field as the United States, but include the correct State and Zip Code, if available and applicable. Thank you!</p> <div class="row"> <div class="col-md-8"> <div id="bbox-root"> </div> <script type="text/javascript">  </script> </div> <div class="col-md-4"> <aside class="sidebar-bs-col"> <section> <h3 class="section-header">Donate Online</h3> <p>Donate as an <a title="Organization" href="/ways-to-give/organizational-donor-form/">Organization</a></p> <p>Donate as a <a title="Corporation" href="/ways-to-give/corporate-sponsor-donation-form/">Corporation</a></p> </section> <section> <h3 class="section-header">Donate by Mail</h3> <p><a title="Donation Form" href="/siteassets/give/individual-donation-form.pdf">Donation Form</a></p> <p><strong>Mail Form to:</strong></p> <p><strong> ASHFoundation</strong> <br />2200 Research Boulevard #105 <br />Rockville, MD 20850-3289</p> </section> </aside> </div> </div> </div> </div> </div> <noindex>  <footer id="footer"> <div class="container padding-t"> <div class="col-xs-12 col-md-8">  <h3 class="text-white text-uppercase">About the ASHFoundation</h3> <div class="clearfix"> <div class="logo-svg pull-left"> <svg class="logo-svg-gradient" version="1.1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" x="0px" y="0px" viewBox="0 0 32 150" style="enable-background:new 0 0 32 150;" xml:space="preserve"> <linearGradient id="GRADIENT_SVG" gradientUnits="userSpaceOnUse" x1="0.9632" y1="266.8125" x2="1.9743" y2="266.8125" gradientTransform="matrix(32 0 0 -32 -31 8613)"> <stop offset="0" style="stop-color:#890C58" ></stop> <stop offset="0.2133" style="stop-color:#8C0F56" ></stop> <stop offset="0.3937" style="stop-color:#971751" ></stop> <stop offset="0.5622" style="stop-color:#A82449" ></stop> <stop offset="0.7234" style="stop-color:#C1373D" ></stop> <stop offset="0.8779" style="stop-color:#E04F2E" ></stop> <stop offset="1" style="stop-color:#FF671F" ></stop> </linearGradient> <rect x="-0.2" y="0" style="fill:url(#GRADIENT_SVG);" width="32.4" height="150" ></rect> <rect x="-0.2" style="fill:none;" width="32.4" height="150" ></rect> </svg> <svg class="logo-svg-mark" version="1.1" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" x="0px" y="0px" viewBox="0 0 86 134" style="enable-background:new 0 0 86 134;" xml:space="preserve"> <rect x="1.5" y="1.3" style="fill:#FFFFFF;" width="8.7" height="71.1" ></rect> <rect x="75.8" y="1.2" style="fill:#FFFFFF;" width="8.7" height="43" ></rect> <rect x="13.6" y="1.2" style="fill:#FFFFFF;" width="11.3" height="99.1" ></rect> <rect x="60.9" y="1.3" style="fill:#FFFFFF;" width="11.3" height="69.3" ></rect> <path style="fill:#FFFFFF;" d="M44.9,130.4c1.8-10.2,3.6-19.7,5.2-30.5c0-0.2,4.8,1.8,7,2.7V1.2H28.2v131.6h28.9v-23.7 c-1.1,5.6-2.9,14.3-5,23.4C52,132.7,46.1,130.8,44.9,130.4z M29.6,107.7c-0.5-9.2,3.3-17.6,9.9-23.8c0.2-0.2-7.4-7.3-7.8-16.8 c-0.6-12.7,9-20.2,9.2-20.4c6.4-7.3,6.7-18.5,6.9-18.3c2.9,4.4,3.5,6.1,5,9.3c1.3,2.7,2.6,6.1,1.6,9.2c-0.8,2.5-3.9,5.9-7.3,10.1 c-2.9,3.6-5.7,4.7-6,20.1c0,0.1,3.3-4.4,4.1-5.7c1.3-2.1,3.5-3.3,5.4-4.7c3.6-2.7,4.5-8.6,4.7-8.8c1.1,3.1,0.8,7.8-1.6,15.1 c-0.1,0.3-3.8,10.3-11.8,11.8c-0.2,2.6,2.3,7.2,2.2,7.4c-0.7,2-1,2.6-1.7,4.3c-1.3,3.5-2.3,6.8-3.4,10.4c-1.4,4.7-3.1,9.6-4.4,14.4 C34.4,121.5,30.1,116.4,29.6,107.7z M36.6,124.3c1.2-3.5,8.3-25.6,9.3-28.6c0.5,0.5,0.9,1,1.5,1.6c-2.3,10.4-3.4,20.6-5.5,31.4 C41.9,128.9,38.5,126,36.6,124.3z" ></path> </svg> </div> <p class="text-white">ASHFoundation supports innovators and sparks innovation in communication sciences. We give early support to promising students, researchers, and clinicians exploring bold ideas to transform the field and improve people's lives.</p> <a href="/Ways-to-Give/Individual-Donor-Form/" class="btn btn-lg btn-gradient">Donate Now</a> </div>  <nav class="footer-nav row"> <div class="col-xs-12 col-sm-4"> <a href="/event-listing/">Events & Deadlines</a> <a href="/news-listing/">News</a> </div> <div class="col-xs-12 col-sm-4"> <a href="/Our-Work/">Donors</a> <a href="/Our-Work/Recipients/">Recipients</a> </div> <div class="col-xs-12 col-sm-4"> <a href="/Our-Work/Board-of-Trustees/">Board of Trustees</a> <a href="/Our-Work/Contact-Us/">Staff</a> </div> </nav> </div> <div class="col-xs-12 col-md-4">  <h3 class="text-white text-uppercase">Connect with us</h3> <div class="social padding-b"> <a href="https://www.facebook.com/asha.org" class="facebook text-white" target="_blank"><i class="fa fa-facebook" aria-hidden="true"></i></a> <a href="https://www.linkedin.com/company/ashfoundation/" class="linkedin text-white" target="_blank"><i class="fa fa-linkedin" aria-hidden="true"></i></a> <a href="https://www.instagram.com/ashfoundationcsd/" class="instagram text-white" target="_blank"><i class="fa fa-instagram" aria-hidden="true"></i></a> <a href="https://www.youtube.com/user/ashaweb" class="youtube text-white" target="_blank"><i class="fa fa-youtube-play" aria-hidden="true"></i></a> <a href="https://www.pinterest.com/ashaweb/" class="pinterest text-white" target="_blank"><i class="fa fa-pinterest-p" aria-hidden="true"></i></a> </div>   <h3 class="text-white text-uppercase">Contact us</h3> <div class="contact-info row"> <div class="col-xs-12 col-sm-6"> <p class="text-white"> Phone:<br /> <a href="tel:+13012968700" class="text-white">301-296-8700</a> </p> <p class="text-white"> For general inquiries:<br /> <a href="mailto:foundation@asha.org" class="text-white">foundation@asha.org</a> </p> <p class="text-white"> For application inquiries:<br /> <a href="mailto:foundationprograms@asha.org" class="text-white">foundationprograms@asha.org</a> </p> </div> <div class="col-xs-12 col-sm-6"> <p class="text-white"> Address:<br /> <a href="https://www.google.com/maps/dir/Current+Location/2200+Research+Blvd,+Rockville,+MD+20850" target="_blank"> 2200 Research Boulevard<br /> Rockville, MD 20850-3289 </a> </p> </div> </div> </div> </div> <div class="container padding-b">  <div class="legalise col-xs-12 col-md-8"> <p class="text-white text-smaller">The ASHFoundation is a 501(c)(3) nonprofit organization under the regulations of the Internal Revenue Service. All contributions to the Foundation are tax-deductible to the extent provided by law.</p> <p class="text-white text-smaller">© ASHFoundation <span id="sYear"></span> | <a href="/privacy-statement/" title="Privacy Statement" class="text-white">Privacy Statement</a> | <a href="/terms-of-use/" title="Terms of Use" class="text-white">Terms of Use</a></p> </div> </div> </footer> </noindex> <script type="text/javascript"> var d = new Date(); document.getElementById("sYear").innerHTML = d.getFullYear();</script> <script type="text/javascript" src="https://dl.episerver.net/13.5.10/epi-util/find.js"></script> <script type="text/javascript"> if(typeof FindApi === 'function'){var api = new FindApi();api.setApplicationUrl('/');api.setServiceApiBaseUrl('/find_v2/');api.processEventFromCurrentUri();api.bindWindowEvents();api.bindAClickEvent();api.sendBufferedEvents();} </script> <a href="#" class="scrollup">To the top</a>  <script src="https://use.typekit.net/jmt8dth.js"></script> <script src="/bundles/foundation/js?v=3bvCf9XjToL8DHdgXfCh2AO-y_sH0wO_uGDkRLpNpXU1"></script> </form> </body> </html>

CINXE.COM

ASHFoundation Individual Donor Form