United Way Pledge Form1.. YOUR CONTRIBUTION Your contribution is your monthly agency fee, which will be determined by SEIU Local 500 and deducted per pay period by GWU Payroll.. CHOOSE O
Trang 1United Way Pledge Form
1 NAME AND CONTACT INFORMATION
FIRST NAME: MI _ LAST NAME: HOME ADDRESS: _ CITY: _ STATE: ZIP: _ HOME PHONE: _ DAYTIME PHONE: _ E-MAIL:
GWID: EMPLOYER: THE GEORGE WASHINGTON UNIVERSITY
2 YOUR CONTRIBUTION
Your contribution is your monthly agency fee, which will be determined by SEIU Local 500 and deducted per pay period by GWU Payroll
CHOOSE ONE OPTION FROM THE FOLLOWING SELECTIONS
SEE UNITED WAY’S WEBSITE FOR CONTRIBUTION OPTIONS HTTPS://UNITEDWAYNCA.ORG/GET-INVOLVED/DONATE/
Option A - CONTRIBUTE TO UNITED WAY OF THE NATIONAL CAPITAL AREA (UWNCA)
Your contribution will be used by the Board of Directors to advance the UWNCA mission.
Option B - CONTRIBUTE TO UNITED WAY’S SPECIAL COMMUNITY INITIATIVES
Your contribution will help solve three of the Greater Washington area’s most critical issues
9072 Education Fund
9073 Financial Stability Fund
9074 Health Fund
Option C - CONTRIBUTE TO UNITED WAY’S COMMUNITY IMPACT FUNDS
Your contributions will fund grants to agency programs as selected by community volunteers.
You may choose to fund the programs for the entire Capital area, or to an individual region.
9000 National Capital Area Community Impact Fund 9005 Loudoun Community Impact Fund
9001 Alexandria Community Impact Fund 9006 Montgomery Community Impact Fund
9002 Arlington Community Impact Fund 9007 Prince George’s Community Impact Fund
9003 District of Columbia Community Impact Fund 9008 Prince William Community Impact Fund [UW]
9004 Fairfax-Falls Church Community Impact Fund
Option D - CONTRIBUTE TO A SPECIFIC AGENCY
Please include the COMPLETE agency address to ensure accurate processing United Way of the National Capital Area Agency
AGENCY NAME _ DIRECTORY CODE _
Other health and human service agency, or other United Way AGENCY NAME _ DIRECTORY CODE
ADDRESS _CITY _STATE _ ZIP
3 SIGN HERE TO AUTHORIZE PLEDGE AND PAYROLL DEDUCTION
I agree that if my designation is to an agency that is not an IRS-recognized 501 (c) (3) or is not in compliance with the United States Patriot Act, then my donation will be directed to the UWNCA Community Impact Fund I agree that any portion of my pledge that is not fully designated will be directed to the UWNCA Community Impact Fund I agree that if for any reason my donation is unclaimed by the designated agency, my donation will be directed to the UWNCA Community Impact Fund Please check here if you prefer that your gift remain anonymous
Please sign and forward to GW Faculty Personnel at 2121 Eye Street, NW, Suite 813, Washington, DC 20052 or via fax (202) 994-5375 For any questions, please contact us at
(202) 994-6783 or facpers@gwu.edu
Rev May 2018