My Information Title - None -Mr.Mrs.Ms.Dr. First Name * Middle Initial Last Name * Suffix Spouse's Title - None -Mr.Mrs.Ms.Dr. Spouse's First Name Spouse's Last Name Spouse's Middle Initial Spouse's Suffix Home Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Email * Preferred Phone Employer Name I have been contributing for ___ years Donation Options How would you like your gift used * Community Fund - the most powerful way to contribute. Dollars are invested by volunteers to address the most critical issues facing our community. Designated to United Way Women United Affinity Group Designated to Other Area United Ways Designated to United Way Agency Partners ***Please note that designated gifts much total at least $50.*** To become a member of the Women United Leadership Council, you must designate at least $1,000 to this specific cause. For more information about Women’s Leadership Council and our Women United affinity group, visit www.unitedwayallencounty.org/womenunited Select Other Area United Way * - Select -008 United Way of Adams County009 United Way of DeKalb County010 United Way of Grant County011 United Way of Huntington County012 United Way of Jay County 013 United Way of Kosciusko County014 United Way of Noble County015 United Way of Wells County016 United Way of Whitley County017 United Fund of LaGrange County018 Steuben County United Way019 Wabash County United Fund Select United Way Agency Partner * - Select -AIH Aging and In-Home Services of Northeast Indiana, Inc.AMR American Red Cross of Northeast IndianaASC Associated Churches of Fort Waye & Allen CountyBBS Big Brothers Big Sisters of Northeast IndianaBLU Blue JacketBGC Boys and Girls Clubs of Fort WayneBRI Brightpoint (formerly CANI)BSC Boy Scouts of America/Anthony Wayne CouncilCSA Cancer Services of Northeast IndianaCAP Caring About PeopleCCH Catholic CharitiesCFN Center for NonviolenceCTN Community Transportation NetworkCYC Cornerstone Youth CenterCVC AMANI Family Services (Crime Victim Care)ECA Early Childhood AllianceEWS East Wayne Street CenterEGH Erin’s House for Grieving ChildrenFWU Fort Wayne Urban LeagueGSC Girl Scouts Northern Indiana-MichianaHWC Headwaters CounselingLBD The LeagueTLA The Literacy AllianceLSS Lutheran Social Services of IndianaMLK Montessori SchoolNHC Neighborhood Health Clinics, Inc.PRC Northeast Indiana Positive Resource Connection (formerly AIDS Task Force)RES The Rescue MissionSAL The Salvation ArmySCN SCAN, Inc.TRN TurnstoneVIN Vincent VillageVNH Visiting NurseWIS Wellspring Interfaith Social ServicesFWB Women’s BureauYMC YMCA of Greater Fort WayneYWC YWCA Northeast Indiana My Community Matters! I have specific interests in the following areas and would like more information about the work United Way is doing to support them Education Financial Stability Healthy Lives Basic Needs Payment Information Amount * Credit Card Number * Expiration Date in MMYY Format * Card Security Code * Public/Private Donor Option By checking this box, my name will not be made public. I understand that I will receive recognition acknowledging that my gift was received by United Way and/or any designated organizations. Electronic Commerce Leave this field blank Submit
