University of Vermont

UVM United Way Campaign Payroll Deduction Pledge Form

UVM United Way Campaign Logo
 
Thank you for participating in the 2016 UVM United Way Campaign.We have set a goal of raising $150,000 from the UVM Community this year. Perhaps more importantly, we would like to increase our participation rate to 15% of eligible employees participating in the campaign.

You may use this on-line form to make a PAYROLL DEDUCTION pledge. Your pledge will be deducted in equal installments from each of your paychecks during the 2017 calendar year.

You may also make a donation using a credit card or check, but we cannot accept those payments on-line. Please print out and complete a paper pledge form and include your payment information:
http://www.uvm.edu/~united/pledgeform.pdf
Mail the pledge form and payment info to: UVM United Way Campaign, c/o Living/Learning Center, 633 Main Street, Burlington, VT 05405-0385

If you have any questions, please send an e-mail to United.Way@uvm.edu or call 802-656-4200.

There are 14 questions in this survey.

Donor Information

Please enter your contact information:
 Your "NetID" is your UVM Network ID, which is what you use to login to your e-mail account (e.g., jsmith1, ftuttle, etc.)
Please indicate if you are a NEW DONOR to the UVM United Way Campaign this year.
Yes, I am a NEW DONOR to this year's UVM United Way Campaign
Please indicate if you are a Loyal Contributor (you have contributed to any United Way for 10 years or more).
YES, I am a Loyal Contributor to United Way.

Payroll Deduction Pledge Information

This on-line form can only be used to make payroll deduction pledges.

If you would like to make a donation via credit card or check, please follow this link to print, complete and mail a paper pledge form:  http://www.uvm.edu/~united/pledgeform.pdf

Please indicate the amount of your payroll deduction pledge, below. Your pledge will be deducted in equal installments from all of your paychecks in calendar year 2017.


Choose one of the following answers
I pledge $52.00 ($1 per week).
I pledge $3.00 per Pay Period.
I pledge $4.00 per Pay Period.
I pledge $5.00 per Pay Period.
I pledge $6.00 per Pay Period.
I pledge $10.00 per Pay Period.
I pledge $25.00 per Pay Period.
I pledge OTHER AMOUNT per Pay Period (please indicate amount per pay period in comment box).

How many times per year do you receive a paycheck?
Choose one of the following answers
24 pay periods
22 pay periods
20 pay periods
18 pay periods
 

Most UVM employees work 12 months, are paid twice a month, and receive 24 paychecks during the calendar year. If you are paid less frequently, please indicate the number of times you are paid each year.

Automatic Pledge Renewal Option


Check here if you would like UVM to renew your pledge automatically each year until you instruct us to discontinue.
 We will send you a courtesy notice each year before we renew your pledge.

UVM Campaign Leadership Giving Levels


UVM has three leadership giving levels:

$500.00 - $749.00: Grace Goodhue Coolidge Leadership Circle
$750.00 - $999.00: George Washington Henderson Leadership Circle
$1,000 and above: Pomeroy Leadership Circle

Please indicate the amount of your leadership pledge, below:
$

Joint Leadership Giving:



Please combine my gift with that of my spouse/partner to qualify as a Leadership Gift. His/her name and employer are:

United Way in Your Hometown

The best investment in your community!


Please choose your United Way

United Ways in Vermont make sure that your investment has the greatest community impact by allocating your gift to a wide range of coordinated local programs with proven results that directly change and improve lives.

 

Please direct my contribution to:
Choose one of the following answers
United Way of Northwest Vermont (Merger of United Way of Chittenden County and Franklin-Grand Isle United Way)
United Way of Addison County
Granite United Way - Upper Valley/Windsor
Green Mountain United Way (serving Caledonia, Essex, Orange, Orleans and Washington Counties)
United Way of Lamoille County
United Way of Rutland County
United Way of Windham County
SUPPORT FOR COMMUNITY IMPACT: As an alternative, I would like my gift to be used to support one or more of the United Way's "Community Impact" areas. (If selecting more than one impact area, please show percentage of gift to go to each area.)

Check any that apply
EDUCATION (Helping children, youth and young adults achieve their potential)
HEALTH (Improving people's health and well-being)
INCOME (Meeting basic needs and promoting financial stability)
DONOR DIRECTED DESIGNATION: I wish to direct a portion of my gift (minimum of $72 per organization) to a specific agency. (I understand that the United Way does not provide fiscal or program oversight. The United Way of Northwest Vermont retains 6% of donations designated to agencies other than Vermont United Ways to defray the administrative costs of processing.)

Check here if you would like your name provided to the designated United Way or non-profit agency.

Check any that apply
Check here if you would like your United Way gift to remain anonymous in any recognition, programs or publications.
Check here if you would like to receive United Way's e-mail updates.

Thank you for your support!

Please let us know if you have any questions or comments.