www.uab.edu/benfund benevolentfund@uab.edu205.934.1581

Contributing Employee Groups:Callahan Eye Hospital • Health Services Foundation

University of Alabama at Birmingham • UAB Health System University Hospital • VIVA Health

give where you

LIVEWORK

PLAY&

Employee Name: _________________________________ Blazer ID: ________________________ (please print your full name)

E-mail: _________________________________________ Campus Phone: __________________

Signature: ______________________________________ Date: ___________________________

Please circle your payroll: UAB Health System HSF Callahan VIVA

_____ Please check here if you are changing your current gift type/amount.

Blazer Giver through payroll deduction

1 HOUR PAY PER MONTH: Blazer Giver (hourly employee)_____ Check to donate one (1) hour of your pay per month.

1 PERCENT PAY PER MONTH: Blazer Giver (salaried employee)_____ Check to donate one (1) percent of your pay per month.

Other Types of Giving*

FIXED AMOUNT PER MONTH through payroll deduction

_____ Check to donate a fixed amount of your choice. Specify amount: $____/month

ONE TIME GIFT_____ Check to donate a One Time Gift. Specify gift amount: $________ Please circle your preferred method for this gift:

Payroll deduction Attached check #_______ (include check number)

Additional One Time Gift to UAB’s Habitat House (#581)*_____ Check to donate a One Time Gift. Specify gift amount: $________

Please circle your preferred method for this gift: Payroll deduction Attached check #_______ (include check number)

*Unfortunately, we cannot accept cash donations.

Leadership GiverEmployees contributing $1,000 or more annually are recognized as UAB Leadership donors. Increasing levels of leadership recognition and matching funds are available to help you step into higher tiers of giving. For more information, contact us.

Print name (may include spouse) as you would like it to appear for recognition purposes:______________________________________________________________________

Initial here if you do not want to be recognized in publicity as a Leadership Giver by the Benevolent Fund or United Way: _______________________

Gift Designation - Give to nonprofits you are passionate about!Up to three designations can be made and may include both designated and undesignated funds. Undesignated funds support Employee Emergency Assistance, Nonprofit Grants and then applied where needed most; for “Undesignated,” use code #000. Please enter the name and/or three digit code assigned to each nonprofit.

1. ________________________ 2. _______________________ 3. ____________________Make checks payable to UAB Benevolent Fund.

Please return this form to the Benevolent Fund office:Campus Address: AB B-84, zip 0100 Email Address: benevolentfund@uab.edu Fax Number: 975.9608

www.uab.edu/benfund

UAB Benevolent Fund Pledge Form

Campus Address: AB B-84, zip 0100 Email Address: benevolentfund@uab.edu Fax Number: 975.9608 www.uab.edu/benfund

Nonprofit Designation ListaTeam Ministries 520A.G. Gaston Boys & Girls Club 034AIDS Alabama 245Alabama Association of Nonprofits 162Alabama Goodwill Industries 119Alabama Head Injury Foundation 110Alabama Kidney Foundation 181Alethia House 101ALS Association - Alabama Chapter 209Alzheimer's of Central Alabama 085Amelia Center 560American Cancer Society 002American Diabetes Association - Alabama Chapter 003American Foundation for Suicide Prevention - AL Chapter 314American Heart Association 274American Red Cross - Mid-Alabama Region 004ARC of Jefferson County 009ARC of Shelby County 171ARC of St Clair County 114ARC of Walker County 010Arthritis Foundation - Southeast Region 008Autism Society of Alabama 287Bell Center for Early Intervention 523Better Basics 172Big Brothers Big Sisters 012Birmingham AIDS Outreach 524Birmingham Education Foundation (Ed) 661Birmingham Jewish Federation 159Birmingham Urban League 015Blazer Kitchen, on-campus food bank 680Blount County - Aid to Homeless Children 152Blount County Central Alabama's Children's Fund 154Blount County Children's Center 095Boy Scouts of America - Black Warrior Council (Tuscaloosa Area) 016Boy Scouts of America - Greater AL Council (Birmingham Area) 166Boys & Girls Club of Central Alabama 014Breast Cancer Research Foundation of Alabama 540Cahaba Valley Health Care 350Camp Fire Boys & Girls - Birmingham Area 020Camp Seale Harris & Camp Sugar Falls (SDES) 355Catholic Family Services 022Childcare Resources 071Children's Aid Society 023Children's Hospital of Alabama 025Christ Health Center 547Christian Love Pantry 115Collat Jewish Family Services 080Community Food Bank of Central Alabama 062Concerned Citizens for Our Youth/ Beacon House 351Crisis Center 027Crohn's and Colitis Foundation - AL / NW FL Chapter 121Cystic Fibrosis Foundation - AL Chapter 028Developing Alabama Youth Foundation 167Disability Rights and Resources 118Easter Seals of the Birmingham Area 173Epilepsy Foundation of Alabama 029Family Connection 133Family Resource Center of Northwest Alabama (Daybreak) 137Fellowship House 033Freshwater Land Trust 662Gateway 030Girl Scouts of North Central Alabama 019Girls Inc. of Central Alabama 035Glenwood Autism and Behavioral Health Center 257

Greater Birmingham Humane Society 663Habitat House - UAB Sponsored 581Habitat for Humanity - Greater Birmingham 138Hand in Paw 542Hands on Birmingham 286Hispanic Interest Coalition of Alabama (¡HICA!) 258IMPACT Family Counseling 175Jefferson County Central Alabama's Children's Fund 153Juvenile Diabetes Research Foundation - Alabama Chapter 038Kid One Transport 032Lakeshore Foundation 664Lakeside Hospice 176Legacy YMCA - Bessemer 068Legal Aid Society 156Leukemia & Lymphoma Society 040Levite Jewish Community Center 037Literacy Council 134Lupus Foundation of America 104Magic City Harvest 665March of Dimes - Alabama Chapter 041M-Power Ministries 544Multiple Sclerosis Society - Alabama Chapter 050Muscular Dystrophy Association of Alabama 045National Alliance on Mental Illness (NAMI) 105Nature Conservancy in Alabama 668Oasis, A Woman's Counseling Center 259Parkinson Association of Alabama 580Pathways 077Planned Parenthood* 151Positive Maturity 052Priority Veteran 640Railroad Park 720Red Mountain Park 660Ronald McDonald House Charities 251Safehouse of Shelby County 277Salvation Army - Greater Birmingham Area 177Salvation Army - Walker County 058Sav-A-Life* 620Shelby County CASA 174Shelby County Central Alabama's Children's Fund 157Shelby County Children's Advocacy Center/Owens House 354Shelby Emergency Assistance 063Sickle Cell Disease Association of America, Central AL Chapter 421Sight Savers 545Smile-A-Mile 541Spina Bifida Association of Alabama 240St Clair Children's Advocacy Center 129St Clair County Central Alabama's Children's Fund 260St Clair County Day Program 206St Clair County DHR 352Susan G. Komen for the Cure - North Central Alabama 312TechBridge 667Travelers Aid Society 060Tuberous Sclerosis Alliance 500United Ability (formerly UCP) 178United Community Centers, Inc. 061United Way of Central Alabama (Birmingham Area) 999United Way of Madison County 600Walker County Central Alabama's Children's Fund 278Workshops, Inc. 067YMCA of Birmingham 069YWCA of Central Alabama 070

*These affiliate agencies receive designations only,they do not receive any undesignated funds

GIVE WHERE YOU...

Ensuring access to necessary health care servicesStewardship of natural resources to fulfill and enrich our livesLIVE

WORK Reducing hunger at UAB by providing fresh, healthy foodFunding research to improve health care outcomes for all

PLAY Providing open places, trails, and water to promote healthy livingHelping patients thrive during treatment and the years beyond

Your pledge to the Benevolent Fund will help transform where we

“Service work is important to the UAB Staff Council. Employees have a wonderful opportunity to donate both money and time to important community projects. Collectively,

small donations add up to big wins. Staff Council is proud to partner

with the Benevolent Fund.” -David Rhodes

Chair- Staff Council, School of Public Health

With designations to 125+ local nonprofits, grant opportunities for additional nonprofits, Employee Emergency Assistance, Blazer Kitchen, and a Habitat House Build, you can make a difference where you live, work, and

play!

LIVEIn 2017, UAB’s fourth Habitat House was sponsored entirely by UAB employee dollars pledged through the Benevolent Fund. Over 675 employees and students contributed more than 3,500 hours to build a home for Ms. Tiffany Wells and her son, Morgan.

UAB Habitat House #581

This brochure highlights a few of the nonprofits to which you can designate your pledge. Charities not listed on the designation list may apply for funding through our

local grant process. For more information and application guidelinesvisit uab.edu/benfund

“UAB employees, thank you. You have blessed me. I’ve never seen people give that much time and energy to anything as they did to building this home.”-Tiffany Wells, Habitat Homeowner

Since 2009, Habitat

has built 50 homes for members of

our UAB family.

WORKEmployee Emergency Assistance Program (EEAP)

Blazer Kitchen #680

EEAP provides confidential financial assistance for employees to help with emergency situations including fire, flood, tornado, illness, or domestic violence.

In its first nine months of operation Blazer Kitchen provided healthy, nutritious food to UAB employees, students and patients in select clinics. Blazer Kitchen engages students in Service Learning and utilizes employee and student volunteers.

“We never know when we may need a helping hand. I had served on the EEAP committee and

was surprised when I needed assistance. Receiving help from coworkers' contributions was

a tearful, thankful moment. I proudly give to the Benevolent Fund.”

-Janet Gillispie, Radiology, UAB Hospital

Over 30,000

Meals provided

Over 1,000 volunteer hours

Over 1450 shopping

visits

"Blazer Kitchen provides almost all the

food I need, it's convenient and the vol-unteers are always ac-commodating and kind.

I especially like the fresh produce. I worry less and am able to focus on my

studies."-Nainish Munot, Graduate Student,

School of Engineering

Over 300 employees& students served

Hand in Paw #542

YOUR TAX DEDUCTIBLE GIFTDesignated Funds:• Agencies you choose• Maximum of three designations• Divided equally between choices • Use three digit agency code

Undesignated Funds:• Employee Emergency Assistance• Local Agency Grants• Community Impact Grant

Designations - Mix and match according to what inspires you to make a difference.

Designation ExamplesExample 1 Leave blank and the entire gift is undesignatedExample 2 1. Agency ### 2. Agency ### 3. Agency ###Example 3 1. Agency ### 2. Undesignated 000 3. __________

Donations will be evenly divided among your choices less operating costs.

BE A BLAZER GIVER. We encourage employees to give at the Blazer level (1 hour per month for hourly employees or 1% per month for salaried employees) to help us make a meaningful impact in Birmingham and throughout Alabama. PLEDGING IS PERSONAL. Your gift will be invested efficiently and effectively according to your choices. YOUR PLEDGE IS VITAL. Your gift is critical to UAB’s collective efforts to positively transform our community. Thank you for your generosity!

Make Your Pledge

PLAY

"I have the privilege of witnessing positive changes and elevated moods

in our patients and staff when therapy teams fill prescriptions for animal as-

sisted therapy. I’m excited UAB is able to help Hand in Paw

expand its programs in our community."-Carolyn Matthews

Volunteer Coordinator, UAB Hospital

UAB employees voted to award the Community Impact Grant to Hand in Paw. Currently, 95

special needs students are working with animal therapy teams. The impact will grow as additional teams are placed in more schools. Evaluations show students have increased focus, improved speech and cognition; decreased anxiety and lower truancy. Teachers give Petscription for the Classroom an A+!

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