SCRIP Designation Form

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Emanuel Lutheran sponsors a SCRIP program which allows the purchase of gift or shopping cards from various merchants and generates rebates from those merchants.The rebates can be used as a credit to your school tuition, a donation to Emanuel, or cash back. Please indicate your choice concerning the use of your rebate.The rebates that you generate will be distributed annually in June.The SCRIP year runs from May 1 - April 30.

Email *

SCRIP Purchaser—First Name: *

SCRIP Purchaser—Last Name: *

SCRIP Purchaser—Address: *

SCRIP Purchaser—Phone Number:

Please select one of the following options: *

Use my portion of the rebate to credit the tuition account of a specific family (Designated below)

Use my portion of the rebate as a gift to Emanuel

Pay my portion of the rebate as cash back to me

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