Company Information Company Name Number of Employees Company Website Physical Address Address City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Zip Code Is the Mailing Address different? Yes No Mailing Address Address City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Zip Code Contact Information Please enter the contact information for the person that will act as the campaign coordinator. Contact Name Contact Title Contact Phone Number Contact Email Campaign Information Campaign Start Date Campaign End Date What are your campaign goals? $ Enter the amount you hope to raise from the main campaign. Are you planning a campaign kick-off event? Yes No Unsure Kick-off Event Date What other campaign activities are you planning? How do you plan to engage employees in this year's campaign? Check all that apply. Staff Meetings Break Room Signage Email Other… Other Pledge Information How would you like to capture pledges this year? Secure Online Link Employees can access a secure link through our website. Pledge reports will be shared with your company's payroll department to set up payroll deductions. Paper Pledge Forms Currently, we do not offer billing options however, once the employee pledge is captured, the employee can pay their pledge via check or with a credit card through our online donation page. Both Paper and Secure Online Link What payroll deduction options would you like to offer employees? Select all of the options you would like to have included on your online pledge form. 1 - A one-time payroll deduction. 12 - Monthly payroll deduction. 24 - Twice monthly deduction 26 - Bi-weekly payroll deduction. 52 - Weekly payroll deduction. Other… Other Pay Period Options Would your pledge form require any other fields for HR such as a department or employee ID number? Campaign Support DIGITAL RESOURCES Email Campaign Toolkit Please check this box if you would like the entire Campaign Toolkit emailed to you. PRINTED MATERIALS United Way Brochures 211 Information 211 is a free and confidential service that connects you with thousands of local programs and services. Simply dial 211 on your phone to reach one of our friendly, trained community resource specialists available 24 hours a day, 7 days a week. Campaign Coordinator Guide & Checklist Campaign Thermometer Campaign Posters ALICE Information ALICE represents individuals and households who earn just above the Federal Poverty Level but less than what it costs to make ends meet. ALICE workers often struggle to afford basic expenses, while keeping our communities running. PRESENTATION OPTIONS Choose one of the following presentation formats: Choose one of the following presentation formats: In-person presentation by United Way staff Remote presentation by United Way staff Pre-recorded presentation by United Way staff None of the above Other Support Please let us know if there are other ways we can support your campaign! Submit Leave this field blank
