STOCK INFORMATION SHEET

Donor's Name:                                                                    Date:                                       

Name of Stock:                                                                                                                   

Symbol:                               Number of Shares:                        Estimated value:$                 

Designation (please check:)    ¨ Annual Fund         ¨ Planned Gift

                                             ¨ Capital (designation:                                                )

                                             ¨    French Camp Academy

                                             ¨    Chamberlain-Hunt Academy

                                             ¨ Other: (please specify:                                                    

Broker's Name:                                                Broker's Number:                                       

Brokerage Firm Name:                                                                                                       

How stock will be conveyed (please check):

     ¨ Electronic Transfer (estimated date of transfer:                                        )

     ¨ Stock certificates and stock power assignment forms in your name

     ¨ Stock certificates in French Camp Academy's name

Additional comments/information:                                                                                           

This form can be faxed to us at (662) 547-9591, or can be mailed to :

If you have any questions, please do not hesitate to contact the French Camp Academy Development Office at (662) 547-9464.  Thank you for your support of French Camp Academy.