Donation Request Form

Contact First Name *

Contact Last Name *

Which of the following methods do you use to raise funds?
Volunteers
Paid Staff
Professional Fund Raiser Which of the following major sources does your funding come from?
United Way Special Events Individuals
Corporate Grants Churches
Foundations Other

Are you a United Way Agency? Yes No Is this request for funds for one fiscal year? Yes No Is this a one-time request? Yes No