1. MY INFORMATION

MY CONTRIBUTION WILL BE PAID AS FOLLOWS:

$

We respect your privacy and do not share your personal information with third parties.

First Name: MI: Last Name:

Home Address: Phone: ( )

City: ST: ZIP:

IU Department (If giving through employee campaign):

SIGNATURE (My signature authorizes my pledge):

Personal E-mail:

I am a Loyal Contributor! I have given to United Way for: 5+ years 10+ years 20+ years

Leave a lasting legacy — Remember United Way in your estate planning.

Keep me updated and show how my contribution is getting results.

I’M GIVING AT A LEADERSHIP LEVEL Vanguard Leadership: My individual or combined gift of

$1,000 or more: Benjamin Harrison ($10,000 +) Platinum ($5,000 - $9,999) Gold ($2,500 - $4,999) Silver ($1,000 - $2,499)

Young Leaders Society: I’m under 40 and my individual or combined gift is $500 or more.

Please combine my leadership gift with that of

_______________________________________________

Please list me (us) in the membership directory as

_______________________________________________NAME / WORKPLACE AFFILIATION (IF DESIRED)

I prefer that my gift remain anonymous

RESTRICT MY CONTRIBUTION: Direct all or part of my gift ($25 minimum per agency) to a United Way member agency or a donor choice agency (listing at www.monroeunitedway.org). I DO NOT want my contact information released to the agency below.

Agency _______________________________________________________________________________________________________________________ Amount $ _________________

2. MY DONATION

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MY TOTAL ANNUAL GIFT

3. MY IMPACT CHOOSE WHERE TO INVEST YOUR GIFT (OPTIONAL)

UNITED WE FIGHT. UNITED WE WIN.WILL YOU JOIN THE FIGHT?

COMMUNITY ACTION FUND: I want my donation to have the most power by supporting 25 member agencies & programs that ensure people learn more, earn more, and lead safer and healthier lives.

PRIORITY FUNDS: I want my dollars to support only agencies & programs in:

EDUCATION EARNINGS ESSENTIALS

Please DO NOT distribute my gift to the following United Way member agency(ies) _________________________________________________________________________

OR

*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 amount withheld and paid to a charitable organization. United Way of Monroe County is a 501(c)(3) non-profit organization and your donation is tax deductible as allowed by current tax law. No goods or services were provided in exchange for this contribution. Consult your tax advisor for more information.

Please return this form to your unit leader.

Vice President for EngagementPoplars 715, 400 East Seventh St. Bloomington, IN 47405812-855-4343(Fax) 812-334-8387www.unitedway.indiana.edu

ONLINE PAYROLL DEDUCTION (pledge online at www.unitedway.indiana.edu) Completed ___/___/2017. . . . . . . . . . . . . . . . . . . . .

DIRECT GIFT (home address needed in Section 1 above) Credit Card (Visit www.monroeunitedway.org/givenow)

Cash/Check (Enclosed — payable to United Way) Check# ___________

Automatic Bank Withdrawal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Attach a voided check — agreement will be mailed to you)

Stocks/Securities (Please call 812-334-8370) . . . . . . . . . . . . . . . . . . . .

Bill Me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Starting in January bill me at address above Monthly Quarterly Semi-Annually Annually

EASY PAYROLL DEDUCTION*

$

$

$

$

X

Amount per pay period

$ =

Total payroll deduction

$

My pay period is Every 2 weeks (24 deductions) Monthly (12 deductions) Monthly (10 deductions)

$

For Office Use Only VP PR UW

2017-2018 DONATION FORMEmployee ID Number (if not pre-printed above)

www.monroeunitedway.org / unitedway.indiana.edu

UNITED WE FIGHT.UNITED WE WIN.

UNITED WAY FIGHTS FOR THE EDUCATION, EARNINGS OPPORTUNITY, AND ESSENTIAL NEEDS OF EVERYONE IN OUR COMMUNITY.

2017-2018 DONATION CARD

Current Collaborations bring key partners together to create a stronger community.

Member Agencies work with United Way to create success in our community thanks to your donations to the Community Action Fund. We are proud to fund these organizations through a volunteer-led grants process. American Red Cross, Southern Indiana Chapter

Amethyst House Area 10 Agency on Aging Big Brothers Big Sisters of South Central Indiana

Boy Scouts – Hoosier Trails Council Boys & Girls Clubs of Bloomington Catholic Charities – Bloomington Community Kitchen of Monroe County Girls Incorporated of Monroe County Hoosier Hills Food Bank Indiana Legal Services LifeDesigns

MCCSC School Assistance Fund Middle Way House Monroe County United Ministries Mother Hubbard’s Cupboard New Hope Family Shelter People and Animal Learning Services (PALS)

Planned Parenthood of Indiana RBB School Assistance Fund Rhino’s Youth Center Salvation Army Shalom Community Center Stone Belt Volunteers in Medicine

2-1-1 Infoline ACA Enrollment Committee ACHIEVE Bank On Bloomington Born Learning Community Organizations Active in Disaster

Dollars and Sense Financial Stability Alliance Free Community Tax Service Kindergarten Countdown Let’s Read High School Plus Coalition Monroe Smart Start Real Men Read

Your funds stay local making it possible for United Way and our network of member agencies and community partners to achieve life-changing results.

Locally, 41% of children qualify for free or reduced lunch at school. Those food needs don’t end when the school bell rings.

$3/week provides a year of healthy groceries and nutrition classes for a family of 4.

With the right modifications and support, most seniors can remain independent and in their own homes longer.

$1/week provides 16 door-to-door trips for a senior unable to drive.

Parents with reliable after school and child care are more likely to keep stable employment and improve their financial situation.

$5/week provides a student with high-quality after school programs and one-on-one tutoring for the school year.

HOW WE FIGHT.

UNITED WE FIGHT. UNITED WE WIN.WHY WE FIGHT.

Only 24% of working age people with developmental disabilities who want jobs are employed.

$2/week provides 8 young adults with disabilities the materials for employment classes.

49% of United Way member agency clients are employed, but often face tough choices to make ends meet.

$3/week provides a family with rent or utility assistance to prevent homelessness.

85% of brain growth happens by age 5. Robust early learning experiences are critical for kids to get a smart start in life.

$20/week provides a young child with a month of high-quality childcare that will help her have a good start in kindergarten.

UNITED WE FIGHT. UNITED WE WIN. WILL YOU JOIN THE FIGHT?Find out how your donation is fighting for our community at monroeunitedway.org/myimpact.

IU Campaign LeadershipIU Campaign Co-ChairDavid B. Johnson Vice Provost, Office of Enrollment Management

Vanguard ChairJim Grandorf, Emeritus Professor of Accounting

IU Campaign ManagerKirk White, Assistant Vice President for Strategic Partnerships

IU Campaign CoordinatorSarah Taylor, United Way Resource Development Director, sarah@monroeunitedway.org

UNITED WE FIGHT...FOR OUR CHILDREN TO ENTER SCHOOL ON THE RIGHT FOOT AND GRADUATE WITH A PLAN.

TO CREATE FINANCIAL OPPORTUNITY.

TO EMPOWER PEOPLE WITH DISABILITIES.

FOR OUR NEIGHBORS WHO NEED FOOD, HEALTH CARE, SHELTER, AND HELP IN A CRISIS.

FOR OUR SENIORS SO THEY CAN AGE WITH DIGNITY.

TO IMPROVE THE QUALITY OF LIFE FOR EVERY PERSON IN OUR COMMUNITY.

UNITED WE WIN.