REACH OUT A HAND TO ONE AND INFLUENCE THE CONDITION OF ALL.
LIVE UNITED
®
Cedar Valley United Way Pledge Form
1. My Information.
MR/MRS/MS/DR
Please print and sign. Your information, including email, is never shared.
FIRST NAME
MI
DEPARTMENT NUMBER
LAST NAME
HOME ADDRESS (For credit card charges, address listed must be your billing address.)
STATE
ZIP
HOME PHONE/CELL PHONE (Please circle)
CITY
WORK PHONE
BIRTH YEAR
COMPANY NAME
PREFERRED EMAIL ADDRESS (Help us be green by providing your email)
SPOUSE/PARTNER
SPOUSE’S/PARTNER’S EMPLOYER
425 Cedar Street, Suite 300
Waterloo, IA 50701
t 319.235.6211
f 319.233.6963
www.cedarvalleyunitedway.org
Follow us and LIVE UNITED
on Facebook, Twitter and
Pinterest.
GIVE. ADVOCATE. VOLUNTEER.
LIVE UNITED
®
Member Rewards Card
Caring Club
®
2. My United Way Investment.
Please select method of contribution.
q Payroll Deduction (Current UNI employees only)
Your final check stub for the year is your receipt.
$________ per pay period X #________ pay periods =
Total $_____________________
Valid through 12/31/14
q Bank Card
¨ Visa ¨ Mastercard ¨ Discover
Card #:___________________________________________
Expiration date:______/______ CVC Code:__________
¨ One Time ¨ Quarterly ¨ Monthly
Total $_____________________
Local businesses want to
thank you for supporting
Cedar Valley United Way by
offering discounts when you
donate $150 annually and
provide your home address
for Caring Club® card
delivery.
q Cash Gift
Receipts are mailed in January for amounts over $250.
q Bill Me
Cash $_____________________
Check $____________________ Check #______________
(payable to Cedar Valley United Way)
Home address required (include in Section 1)
¨ One Time ¨ Quarterly ¨ Monthly
Total $_____________________
Total $_____________________
3. More About Me. Need help? Call 2-1-1 and get
the answers you need. This
3-digit number can connect you
to human services available
here in the Cedar Valley.
Please identify me in the following ways (check all that apply).
q Cedar Society for Leadership Giving
q Emerging Leader’s Society
My gift of $1,000 or more qualifies me.
My gift of $500 or more AND my age of 40
or younger qualifies me.
Please list my/our name(s) as follows for
recognition:
____________________________________
q I would like to learn more about my
q I prefer that my gift remain anonymous.
q Women’s Philanthropy Connection
My role as a woman in the Cedar Valley
AND my gift of $1,000 or more OR my
gift of $500 or more AND my age of 40 or
younger qualifies me for membership.
membership options. Please contact
me using the email information I have
provided at the top of this form.
q I am a UNI Alumni
Year:___________
4. My Signature. Required for processing.
Signature:__________________________________________________ Date:___________________________
Your contribution is fully tax deductible. No goods or services were provided in exchange for this contribution. We comply with the
United States Patriot Act.
Directed Gift. Optional. To minimize processing costs we request directed gifts of $50 or more.
Community Impact. Please direct my investment toward the following area.
$____________ Education $____________ Income $____________ Health $____________ United Way Endowment
Specific Non-Profit Agency. Directed gifts to specific 501(c)3 agencies are not reviewed or held accountable for results by United Way.
By not directing your donation, your contribution automatically goes toward the Community Impact Fund which produces measurable
results that strengthen our community. Each directed gift must be at least $50. Cedar Valley United Way keeps a small portion of each
directed gift to cover administrative costs and pledge loss as determined annually by its Board of Directors. Your information will be
released to agencies to which you direct funds.
Agency Name:____________________________________________ Agency Address:___________________________________________
Agency Phone:___________________________________________ Directed Amount: $_________________________________________
THANK YOU
FOR GIVING TO
CEDAR VALLEY UNITED WAY.
YOU
ARE
LIVING UNITED AND
HELPING
MAKE A DIFFERENCE
IN OUR COMMUNITY.
YOUR CONTRIBUTIONS FUND PROGRAMS THAT
WORK IN THESE CRITICAL AREAS
EDUCATION
Helping youth achieve their potential through education
· Creating productive and engaged young adults
· Partnering with schools and parents to improve academic
achievement in children
INCOME
Helping families become financially stable & independent
· Increasing income by helping hardworking people obtain job
training and family-sustaining wages
· Encouraging savings as a financial safety net
HEALTH
Improving people’s health
· Empowering individuals by reducing substance abuse, child
abuse and domestic violence
· Increasing health education and preventive care
· Improving maternal health and infant well-being
UNITED FOR THE COMMON GOOD
Cedar Valley United Way’s focus is on education, income
and health—the building blocks for a good quality of life.
We recruit people and organizations who bring the passion, expertise and resources needed to get things done
in our community.
Join Cedar Valley United Way in tackling challenging
community issues. Give to Cedar Valley United Way. Your
contributions support programs that make a real difference
in the Cedar Valley.
BE A LEADER
Any gift to United Way makes you a hero in our
community. Consider making your gift a Leadership Gift.
Cedar Society for Leadership Giving Levels
Tocqueville Society $10,000 or more
Golden Bough
$5,000 to $9,999
Silver Bough
$2,000 to $4,999
Bronze Bough
$1,000 to $1,999
Cedar Society for Leadership Giving recognizes donors
who contribute $1,000 or more to United Way.
Women’s Philanthropy Connection members express
their philanthropic passion through education,
mentoringand volunteering. Women in households giving
$1,000 or more or $500 or more and 40 and under can
join.
Emerging Leaders are 40 and under and give $500 or
more to United Way.
Non-profit grant partners for programs in 2014-15 include: Allen College,
ASPIRE, Big Brothers Big Sisters of Northeast Iowa, Blue Zones Project,
Boys and Girls Clubs of Northeast Iowa, Buchanan County Volunteer
Services, CASA, Cedar Valley Friends of the Family, Cedar Valley Preschool
& Child Care, Cedar Valley United Way, Christian Community Development,
Community Housing Initiatives, Community Partnership for Protecting
Children, Exceptional Persons Inc., Family & Children’s Council of Black
Hawk County, Family YMCA of Black Hawk County, Friends of Hartman
Reserve, Girl Scouts of Eastern Iowa & Western Illinois, Grin and Grow Ltd.,
Hawkeye Chapter of the American Red Cross, Hawkeye Community College,
Iowa Legal Aid, Job Foundation, Lutheran Services in Iowa, Operation
Threshold, NAMI Black Hawk County, Northeast Iowa Area Agency on Aging,
Northeast Iowa Food Bank, Operation Threshold, Pathways Behavioral
Services, Peoples Community Health Clinic, Success Link, The Salvation
Army, UnityPoint Health—Allen Hospital, Veridian Credit Union, Volunteer
Center of Cedar Valley, Waterloo Visiting Nurses Association, Waypoint
Services, Wheaton Franciscan Health System and YWCA of Black Hawk
County.