Palmateer Scholarship Form

The Sgt. Mark C. Palmateer Memorial Scholarship

Personal Information

Prefix First Name Middle Name Last Name Suffix

Are you affiliated with Dutchess Community College?

I'd like to make a gift to the scholarship of $

Mailing Address


Street Address City State Zip Code

Contact Information

Home Telephone Cell Telephone E-mail Address
Account Used: MasterCard VISA DISCOVER American Express

Credit Card Information (This is the only method of payment available for online registration.)

I,[Card Holder Name]

Card Number (no spaces or dashes)
CVV Number
Expiration Date MM/YY

Other Information

My employer or my spouse's employer will match my gift. I will mail a matching gift form to you.

Dutchess Community College Foundation
53 Pendell Rd.
Poughkeepsie, NY 12601