LIVE UNITED
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United Way Pledge Form
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First NameMI
Last NameBirth Month/ Year
BE PART OF THE SOLUTION.
Street Address or PO Box
CityState
Phone
q Home
JOIN US!
q Work
Zip
q Cell
Please check box if you are planning
q to retire in the next 12 months.
Company
q Please register me for the United Way Loyal Contributors Program
I have been contributing to United Way since
________
(year).
United Way of Greater Stark County is committed to a healthy
community where kids are successful from kindergarten
through graduation to a career, and families have the
tools, skills and support they need to become financially
independent. Through your support, United Way is building
a stronger community, committed to strategic investments
with long-term results.
Do you want to know how your gift is helping people? Please provide your email address
2
How do you want to help? (mark your choice below)
below so we can show you how your contribution is making a difference, and to provide you with opportunities to
give, advocate and volunteer throughout the year. EMAIL
My Total Gift
q United Way’s Community Fund
is the best way to help the most
people
$_______________
Please Select a Payment Option
OR, choose a BUILDING BLOCK impact area:
q Payroll Deduction $__________________ per pay period
q EDUCATION
Pay frequency ________________
(Number of pay periods per year)
ENSURE academic and future success for all children
q Cash or Personal Check
Personal check # _________
(Please make check payable to United Way of Greater Stark County)
q Please Bill Me at the Address listed above (Minimum $25)
Choose: q Semi-annually q Quarterly q Monthly
q INCOME
q Credit Card
qOne-time Charge $_____________
EQUIP families with the tools and skills to achieve
financial independence
q Monthly Charge $______________
Visa/Mastercard/Discover/American Express #
Exp. date
q HEALTH
Security #
PROMOTE a healthy community
qSecurities please call 330-491-9961 for the Finance Dept. when you are ready to transfer funds
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Affinity Groups (Please check all that apply and see reverse side for descriptions)
qLeaders In Giving
qStep-Up to Leaders In Giving
qWomen’s Leadership Council
qWomen’s Leadership Council Engaged Contributor
qYoung Leaders Society
qYoung Leaders Society Engaged Contributor
qYoung Leaders Society Community Advocate
qAlexis de Tocqueville Society
qStep-Up to Alexis de Tocqueville Society
Spouse/Partner Gift $_____________ Combined Total $__________________
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Spouse/Partner Name______________________________________________
His/Her Company__________________________________________________
Signature (required) Date
DONOR AND CAMPAIGN COORDINATOR: Please make the necessary copies for your records.
OR, designate to another United Way or other health and human
service agency:*
Donations may be designated to another 501c3 health and human service agency. United Way
of Greater Stark County does not endorse or provide oversight to any nonprofit organization
unaffiliated with United Way. See donor designation policy on reverse.
*
United Way of Greater Stark County
401 Market Ave. N., Suite 300, Canton, OH 44702
330-491-0445 uwstark.org
Thank you for your contribution. No goods or services were provided in exchange for this
contribution. Please keep a copy of this form for your tax records. You will also need a copy of your
pay stub, W-2 or other employer document showing the amount withheld and paid to a charitable
organization. Consult your tax advisor for more information.
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ONE GIFT
SHAPES THE FUTURE
Suggested Giving
Annual Salary
Up to $10,000
$10,001-$15,000
$15,001-$20,000
$20,001-$26,000
$26,001-$35,000
$35,001-$50,000
Over $50,000
% Income
0.60%
0.80%
1.00%
1.25%
1.50%
1.75%
2.00%
Twice a Month
Up to $2.50
$3.33 to $5.00
$6.25 to $8.33
$10.42 to $13.54
$16.25 to $21.88
$25.52 to $36.46
$41.67 and up
• Leaders In Giving Gift of $1,000 or more
• Step-Up to Leaders In Giving Initial gift of $500 or more and a
commitment to reach $1,000 within five years
Year 1: $500
Year 2: $600
Year 3: $750
Year 4: $900
Year 5: $1,000
• Women’s Leadership Council Women or spouses of donors giving
$1,000 or more
• Women’s Leadership Council Engaged Contributor Women or
spouses of donors giving $250 or more with a commitment to ten
volunteer service hours with United Way
• Young Leaders Society Donor Gift of $1,000 or more or enrollment
into the Step-Up to Leadership program
• Young Leaders Society Engaged Contributor Gift of $120 or more
and commitment to 10 volunteer service hours annually with United
Way
• Young Leaders Society Community Advocate Volunteer
commitment of 20 hours of service annually with United Way
• Alexis de Tocqueville Society Gift of $10,000 or more
• Step-Up to Alexis de Tocqueville Society Leaders who make a
$5,000 initial gift and commit to reach $10,000 within five years
Your Gift Can Provide Three hours of money management training and budget coaching
Three hours of group treatment for a preschooler with severe developmental, behavioral & emotional problems
Six youth with a safe place to learn and grow after school for one week
One language & literacy kit for a class of 20 preschool children
Seven days of lunches for 40 children
Glucometer and one-year supply of test strips for four people with diabetes
Ten weeks of day care including healthy snacks for a toddler from a low income family UNITED WAY’S DONOR DESIGNATION POLICY
The purpose of the Donor Designation Policy is to establish
guidelines for donors that will align with United Way of Greater
Stark County’s Strategic Plan. The Policy was developed to
encourage growth in United Way’s mission while still respecting the
donor’s choice.
Revised April 14, 2011
United Way of Greater Stark County has two types of Community
Partners:
1.
Funded Partners are those agencies that are currently
receiving funding through United Way’s allocations process.
2.
Affiliate Partners are not currently receiving funding through
the allocations process, but they meet all United Way
standards for membership and can apply for funding at the
beginning of the next two year funding cycle.
Donations can be designated to a United Way Impact Area, a
specific United Way Community Partner, a United Way Strategic
Initiative, other United Ways or any health or human services
501(c)(3) organization.
No fee will be deducted from any designations.
Join an Affinity Group
uwstark.org
Designations to a non-United Way health or human services
provider:
1.
Number of designations is not limited.
2.
Non-United Way health or human services providers will be
required to submit its certified, signed copy of the Patriot
Act Agreement, a copy of 501(c)(3) status and mission
statement in order to receive the donation.
3.
Designations exclude civic (i.e. Rotary, Lions Club), religious
(i.e. synagogue, church), educational (i.e. school, university)
or arts-related (i.e. symphony, art museum) organizations.
•
Religious designations will be accepted if the designation is to a
direct health and human service program within the church, i.e.,
soup kitchen. Unrestricted designations to a general fund are not
permitted.
•
Any designations to United Way’s Funded Partners are
treated as first-in dollars. Total donor designations that
exceed the allocated amount to a Funded Partner will be
given in addition to that Funded Partner’s allocation, and
will be paid to them as such designations are received by
United Way.
•
Designations to Affiliate Partners will be paid to them as
such designations are received by United Way.
•
•
•
•
United Way will accept designations that may exclude a
specific Impact Area or Funded Partners.
United Way will not accept designations to non-funded
programs of Funded Partners.
United Way recognizes that some Leadership givers ($1,000
and above) choose to designate their donations to non
United Way agencies or programs. However, United Way
encourages all Leadership givers to donate at least 50% of
their gift to United Way, a United Way Impact Area, a specific
United Way Community Partner, a United Way Strategic
Initiative or other United Ways.
Leadership givers will be recognized in all United Way
publications at the dollar amount pledged, regardless if
any or all of the pledge is designated to a non United Way
agency or program.
In kind gifts will be recognized, at the appropriate giving
level, in all United Way publications.
Designations that do not correspond with this policy will be
addressed on an individual basis through personal, phone or
written communication between United Way of Greater Stark County
and the individual donor or donor company.
ONE encouraging word can give a child confidence to succeed. ONE smile can better
someone’s day. ONE gesture can change an obstacle into an opportunity. ONE generous
gift can alter someone’s future. With your help, United Way of Greater Stark County is
making quality EDUCATION, INCOME and HEALTH accessible to everyone in our community.
Visit uwstark.org for more on how United Way is helping.
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