thank you for living united! · 01951 National Alliance on Mental Illness - NAMI Wisconsin ......

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7/14 YOUR INFORMATION Please print clearly. Your information is kept confidential and will not be sold or shared. m Mr. m Mrs. m Ms. m Dr. Name ______________________________________________________________ Home Address ______________________________________________________ City___________________________________ State_____ Zip______________ Employer _________________________________________________________ Employee ID (if applicable)________________________________________________ Phone (________)________________________ m Home m Work m Cell Personal Email __________________________________________________ Work Email _____________________________________________________ Date of Birth ______/______/______ o Easy payroll deduction A. Amount per pay period X B. Pay periods per year = $ ______________________ 1 SELECT PAYMENT OPTION 2 Annual payroll deduction (A x B) o Deduction from my bonus $ ______________________ o Payment enclosed $ ______________________ m Check (Payable to United Way of Greater Milwaukee) m Cash o Securities/Stock (Please call 414.263.8144 for more information) m Payroll deduction m Check # ______________________________________ Exp _________ m Visa m MasterCard m Discover m AmEx Charge me: m Once m Monthly m Quarterly m Semi-Annually Begin Date: ____/____ /____ o Bill me for a gift of $ ______________________ m Once m Quarterly m Semi-Annually Begin Date: _____ /_____ /_____ $10 Minimum Annual Campaign Pledge Form o Education (45): Help children & youth achieve their potential. Robert W. Baird & Co. Inc. matches donations. $ __________ o Income (55): Promote financial stability & independence. MillerCoors matches donations. $ __________ o Health (65): Improving people's health & safety. $ __________ MAKE YOUR GIFT 3 o United Way's Community Impact Fund (13439): Your gift to United Way's Community Impact Fund makes you a partner in addressing our community's most crucial needs. $ __________ o Emerging Leaders Program: I give $1,200+ individually or with my partner. (Recommended age: 20s, 30s & 40s.) o Women's Leadership Program: I give $1,200+ individually or $2,400+ with my partner. o IT United: I am an information technology professional and give $1,200+. o Loyal Contributor: I have a 10+ year history of giving. o Diamond Donor: I am a loyal contributor with 25+ year history. TELL US ABOUT YOU 4 Legacy Society o I would like information on planned giving. o I have already included United Way in my estate plans. m Do not release my name to the agency. $ ________________________ TOTAL ANNUAL GIFT ______________________________________________ _________________ SIGNATURE X DATE No goods or services were provided in exchange for this contribution. Please keep a copy of this form for your tax records. Pledges paid through payroll deduction also require a copy of your pay stub, W-2 or other employer document showing amount withheld. Consult your tax advisor for more information. Thank you for Living United! m $5 m $10 m $25 m $50 m $100 m Other ________ m 12 monthly m 24 semi-monthly m 26 every other week m 52 weekly m Other _______ o Community Health Clinics (40): Expand primary care & preventive services. Milwaukee Health Care Partnership matches donations. $ _________ o Healthy Girls (70): Teen pregnancy & sexual victimization prevention. Aurora Health Care matches donations. $ _________ o Healthy Birth Outcomes (30): Infant mortality prevention. BMO Harris Bank matches donations. $ _________ o Individual Development Accounts (75): Match savings for postsecondary education or to buy a first home. $ _________ o Milwaukee Succeeds (50): Provide early literacy & school readiness support. Sigma-Aldrich matches donations. $ _________ o Direct my gift to the following agency (see back): $ _________ Code __________ Name __________________________________ Address ________________________________________________ Please include personal email to receive community results and news from United Way. o Credit card payment $ ______________________ $ ________________________ Total from this section Total annual gift above must match total from this section.

Transcript of thank you for living united! · 01951 National Alliance on Mental Illness - NAMI Wisconsin ......

Page 1: thank you for living united! · 01951 National Alliance on Mental Illness - NAMI Wisconsin ... Central Wisconsin Affiliate 02062 Susan G. Komen for the Cure - South Central Wisconsin

7/14

Your InformatIonPlease print clearly. Your information is kept confidential and will not be sold or shared.m Mr. m Mrs. m Ms. m Dr.

Name ______________________________________________________________

Home Address ______________________________________________________

City___________________________________ State_____ Zip______________

Employer _________________________________________________________

Employee ID (if applicable)________________________________________________

Phone (________)________________________ m Home m Work m Cell

Personal Email __________________________________________________

Work Email _____________________________________________________

Date of Birth ______/______/______

o Easy payroll deduction a. Amount per pay period x B. Pay periods per year = $ ______________________

1

Select paYment optIon2

Annual payroll deduction (A x B)

o Deduction from my bonus $ ______________________

o Payment enclosed $ ______________________ m Check (Payable to United Way of Greater Milwaukee)m Cash

o Securities/Stock (Please call 414.263.8144 for more information)

m Payroll deduction m Check

# ______________________________________ Exp _________ m Visam MasterCard m Discoverm AmEx

Charge me: m Once m Monthly m Quarterly m Semi-Annually

Begin Date: ____/____ /____

o Bill me for a gift of $ ______________________ m Once m Quarterly m Semi-Annually Begin Date: _____ /_____ /_____$10 Minimum

annual campaign pledge form

o Education (45): Help children & youth achieve their potential. Robert W. Baird & Co. Inc. matches donations. $ __________

o �Income (55): Promote financial stability & independence. MillerCoors matches donations. $ __________

o Health (65): Improving people's health & safety. $ __________

make Your GIft3o United Way's Community Impact Fund (13439):

Your gift to United Way's Community Impact Fund makes you a partner in addressing our community's most crucial needs. $ __________

o Emerging Leaders Program: I give $1,200+ individually or with my partner. (Recommended age: 20s, 30s & 40s.)

o �Women's Leadership Program: I give $1,200+ individually or $2,400+ with my partner.o IT United: I am an information technology professional and give $1,200+.o Loyal Contributor: I have a 10+ year history of giving. o Diamond Donor: I am a loyal contributor with 25+ year history.

tell uS aBout You4Legacy Society

o I would like information on planned giving. o I have already included United Way in my

estate plans.

m Do not release my name to the agency.

$ ________________________total annual GIft ______________________________________________ _________________SIGnature X

Date

No goods or services were provided in exchange for this contribution. please keep a copy of this form for your tax records. Pledges paid through payroll deduction also require a copy of your pay stub, W-2 or other employer document showing amount withheld. Consult your tax advisor for more information. thank you for living united!

m$5 m$10 m$25 m$50 m$100 mOther ________

m12 monthly m24 semi-monthly m26 every other week m52 weekly mOther _______

o Community Health Clinics (40): Expand primary care & preventive services. Milwaukee Health Care Partnership matches donations. $ _________

o Healthy Girls (70): Teen pregnancy & sexual victimization prevention. Aurora Health Care matches donations. $ _________

o Healthy Birth Outcomes (30): Infant mortality prevention. BMO Harris Bank matches donations. $ _________

o Individual Development Accounts (75): Match savings for postsecondary education or to buy a first home. $ _________

o Milwaukee Succeeds (50): Provide early literacy & school readiness support. Sigma-Aldrich matches donations. $ _________

o Direct my gift to the following agency (see back): $ _________ Code __________ Name __________________________________ Address ________________________________________________

Please include personal email to receive community results and news from United Way.

o Credit card payment $ ______________________

$ ________________________total from this section Total annual gift above must match total from this section.

Page 2: thank you for living united! · 01951 National Alliance on Mental Illness - NAMI Wisconsin ... Central Wisconsin Affiliate 02062 Susan G. Komen for the Cure - South Central Wisconsin

A processing fee & estimated losses for uncollectible pledges on deferred billing will be deducted as pledge is paid out. Estimated losses for uncollectible pledges on deferred billing will be deducted as pledge is paid out.

The agencies listed below receive program funding from United Way. However, your designated gift is paid out to the agency separately from and in addition to its annual United Way allocation.

The organizations listed below do not receive annual program funding from United Way. These agencies are listed because they received the highest number of designations last year or were prior year agency program partners and ran a United Way campaign.

The organizations listed below do not receive United Way funding. They are listed as part of an agreement with United Way and Community Health Charities of Wisconsin.

a gift to united Way is the easiest way to make an impact in our community

Giving to United Way is the most efficient and powerful way to invest in Greater Milwaukee. United Way invests your dollars in: strategic focus areas, opportunity fund grants, urgent need fund grants, healthy girls initiative grants and more.

Together we are creating a better life for all through the Education, Income and Health strategic focus areas.

meet JackJack’s parents were wary of sending him to summer camp on his own. But Jack, a 9-year-old boy with Down syndrome fit right in.

His positive attitude made him a quick favorite and he made friends fast – friends like, Benji. “I like making new friends...we had a lot of fun,”

Benji recalls. “No matter what ability you have, you can always have fun like we did at camp.”

Jack participated in all of the same activities as the other kids, including an overnight session. His parents were in awe of his new confidence. “This was the first time he got to be one of the boys,” says Jack’s mom, Johanna. “We weren’t sure he would ever get these opportunities.”

United Way funds programs that serve children and adults with disabilities, as well as their caregivers, helping them reach their full potential.

See Jack's story at UnitedWayMilwaukee.org/Jack

Milwaukee County01560 AIDS Resource Center of Wisconsin, Inc. 03400 American Red Cross in Southeastern Wisconsin23250 Aurora Family Service, Inc. 81975 Aurora Visiting Nurse Association of WI06750 Bay View Community Cente, Inc. 07580 Big Brothers Big Sisters of Metropolitan Milwaukee, Inc. 47775 Boys & Girls Clubs of Greater Milwaukee, Inc.70201 Bread of Healing Clinic, Inc. 11189 Cathedral Center, Inc. 11325 Catholic Charities of the Archdiocese of Milwaukee, Inc.49425 Center for Communication, Hearing & Deafness, Inc.12001 Centro Legal12900 Children’s Hospital of Wisconsin Community Services81650 City Year, Inc. 12825 COA Youth & Family Centers 14850 Community Advocates, Inc.70203 Community Outreach Health Clinic17100 Council for the Spanish Speaking, Inc.18300 Curative Care Network, Inc.70200 Diverse & Resilient, Inc. 26050 Fondy Food Center, Inc. 26086 Friedens Community Ministries, Inc. 27225 Girl Scouts of Wisconsin Southeast, Inc. 27788 Grand Avenue Club, Inc. 57575 Guest House of Milwaukee Inc.37275 Harry & Rose Samson Family Jewish Community Center57576 The Healing Center 33732 Housing Resources, Inc. 48600 IMPACT, Inc.68250 IndependenceFirst, Inc. 36450 Interfaith Older Adult Programs, Inc. 36825 International Institute of Wisconsin 37350 Jewish Family Services, Inc. Robert & Mimi Habush Family Center39625 La Causa, Inc. 40950 Legal Aid Society of Milwaukee41385 Literacy Services of Wisconsin, Inc.46050 Mental Health America of Wisconsin, Inc.

46200 Meta House, Inc. 47925 Milwaukee Christian Center, Inc. 49805 Milwaukee LGBT Community Center 50775 Milwaukee Urban League51040 The Milwaukee Women’s Center, Inc. 54600 Neighborhood House of Milwaukee, Inc. 54825 New Concept Self Development Center, Inc. 55375 Next Door Foundation, Inc. 43125 Nonprofit Center of Milwaukee, Inc. 58500 Parenting Network, Inc 17475 Pathfinders70100 PEARLS for Teen Girls, Inc. 59100 Penfield Children’s Center80100 Safe Babies Healthy Families, Inc. 65335 S.E.T. Ministry, Inc43250 St. Elizabeth Ann Seton Dental Clinic70500 St. Joseph Academy, Inc. 66075 The Salvation Army 69675 Silver Spring Neighborhood Center, Inc. 33325 Sixteenth Street Community Health Center, Inc.70425 Sojourner Family Peace Center, Inc.08850 Three Harbors Council - Boy Scouts of America12000 United Community Center, Inc.11400 Vision Forward Association, Inc.82650 Walker’s Point Youth & Family Center, Inc.86250 Wisconsin Community Services, Inc. 89400 YMCA of Metropolitan Milwaukee, Inc. 89925 YWCA Southeast Wisconsin Ozaukee County 01428 Advocates of Ozaukee 07650 Big Brothers Big Sisters of Ozaukee County16350 COPE Services, Inc. 23175 Ozaukee Family Services 60900 Portal, Inc. 57975 Starting Point of Ozaukee, Inc.82375 Volunteer Center of Ozaukee County 89810 The Youth & Family Project, Inc.

Washington County11325 Catholic Charities of the Archdiocese of Milwaukee, Inc.17275 Elevate, Inc.26100 Friends of Abused Families, Inc.

United Way in Waukesha County *denotes agencies also funded by United Way of Greater Milwaukee01255 Adaptive Community Approach Program, Inc. (ACAP)03525 American Red Cross in Southeastern Wisconsin*83850 Association for the Rights of Citizens with handicaps (ARCh)07575 Big Brothers Big Sisters of Metropolitan Milwaukee

& Waukesha Co., Inc.*08925 Boy Scouts of America, Potawatomi Area Council11193 Catholic Charities of the Archdiocese of Milwaukee, Inc.* 15060 Community Outreach Health Clinic*18305 Curative Care Network*21901 Easter Seals Southeastern Wisconsin23325 Family Service of Waukesha County27075 Girl Scouts of Wisconsin Southeast, Inc.*27077 GPS Partners for Education31540 Hebron House of Hospitality, Inc.36050 Interfaith Senior Programs, Inc.39600 La Casa de Esperanza, Inc.83930 Literacy Council of Greater Waukesha, Inc.42775 Lutheran Social Services of Wisconsin & Upper Michigan, Inc.15810 NAMI Waukesha, Inc. National Alliance on Mental Illness61430 Parents Place64024 Richard’s Place, Inc.80105 Safe Babies Healthy Families, Inc.*66225 Salvation Army – Waukesha71325 St. Joseph’s Medical Clinic72320 Stillwaters Cancer Support Services10925 The Caring Place, Inc.88500 The Women’s Center, Inc.27076 Waukesha County Community Dental Clinic86255 Wisconsin Community Services, Inc.*89475 YMCA at Pabst Farms89550 YMCA of Central Waukesha County

united Way agency program partners

86075 Community Health Charities of Wisconsin00134 ABCD: After Breast Cancer Diagnosis02040 AIDS Research Foundation - amfAR02053 Alliance for a Healthier Generation - Childhood Obesity02044 ALS Association - Wisconsin Chapter02250 Alzheimer's & Dementia Alliance of Wisconsin02041 Alzheimer's Association - Greater Wisconsin02047 Alzheimer's Association - South Central Wisconsin02251 Alzheimer's Association - Southeastern Wisconsin02726 American Cancer Society02851 American Diabetes Association00133 American Kidney Fund03094 American Liver Foundation - Wisconsin Chapter03111 American Lung Association in Wisconsin85505 American Parkinson Disease Association - Wisconsin Chapter85731 ARC - Wisconsin Disability Association04950 Arthritis Foundation - Upper Midwest Region00136 Autism Society of South Central Wisconsin05691 Autism Society of Southeastern Wisconsin00137 Badger Childhood Cancer Network02048 Be the Match Foundation85800 Brain Injury Alliance of Wisconsin10500 Breast Cancer Recovery02049 Bryon Riesch Paralysis Foundation02050 CaringBridge02052 Cerebral Palsy International Research Foundation

85802 City of Hope16599 CORE / El Centro00145 Crohn's & Colitis Foundation18581 Cystic Fibrosis Foundation - Wisconsin Chapter00139 Down Syndrome Association of Wisconsin22495 Endometriosis Association22510 Epilepsy Foundation of Southeastern Wisconsin00146 Faith's Lodge 51888 Free to Breathe (formerly National Lung Cancer Partnership)28413 Great Lakes Hemophilia Foundation02252 Health First Wisconsin33355 HOPE of Wisconsin00147 Hospice Alliance 34350 Huntington's Disease Society of America - Wisconsin State Chapter00140 InHealth Community Wellness (Free) Clinic02054 JDRF International - Northeast Wisconsin Chapter38085 JDRF International - Southeast Wisconsin Chapter02055 JDRF International - Western Wisconsin Chapter41326 Leukemia & Lymphoma Society - Wisconsin Chapter86080 Life Navigators02056 LifeStriders43200 MACC Fund (Midwest Athletes Against Childhood Cancer)43540 Make-A-Wish Foundation of Wisconsin00148 March of Dimes 52076 Muscular Dystrophy Association - Wisconsin Chapter52101 Myasthenia Gravis Foundation of America - Wisconsin Chapter

community Health charities of Wisconsin

01951 National Alliance on Mental Illness - NAMI Wisconsin53342 National Kidney Foundation of Wisconsin51926 National Multiple Sclerosis Society - Wisconsin Chapter02057 National Psoriasis Foundation10801 One Heartland31215 Outreach Community Health Centers 02058 Pancreatic Cancer Action Network60376 Planned Parenthood of Wisconsin53904 Prevent Blindness Wisconsin45275 Ronald McDonald House Charities of Eastern Wisconsin02060 Ronald McDonald House Charities of Madison85509 Southeastern Wisconsin Adaptive Ski Program (SEWASP)71305 St. Jude Children's Research Hospital00143 Stillwaters Cancer Support Services02051 Susan G. Komen for the Cure - Central Wisconsin Affiliate02062 Susan G. Komen for the Cure - South Central Wisconsin Affiliate28989 Susan G. Komen for the Cure - Southeast Wisconsin Affiliate02063 United Cerebral Palsy of Greater Dane County76351 United Cerebral Palsy of Southeastern Wisconsin00144 Variety - The Children's Charity of Wisconsin85601 Wisconsin Association for Perinatal Care85510 Wisconsin Dental Association Foundation85511 Wisconsin Parkinson Association88140 Wisconsin Women's Health Foundation

03750 American Heart Association Greater Midwest Affiliate12800 Children's Hospital of Wisconsin22880 Evangelical Child & Family Agency26490 The Gathering of Southeast WI, Inc.27450 Goodwill Industries of SE WI49435 Hunger Task Force, Inc.

38028 Junior Achievement of Wisconsin, Inc.45685 Medical College of Wisconsin49300 Milwaukee Habitat for Humanity35602 Milwaukee Health Services56100 Northcott Neighborhood House, Inc.35603 Progressive Community Health Centers

In 2012-13, United Way funded 62 health programs serving nearly 235,000 people.

Our goals in Health are to increase the number of youth and adults who:

• Are healthy and safe

• Are able to live independently and with dignity

• Have access to high quality and affordable mental, behavioral, dental and general health care

• Have access to prevention education and can avoid risky behaviors

• Have a network of support for children with disabilities, their families and caregivers

• Have access to healthy, local, and affordable fresh fruits and vegetables

• Have access to high quality, affordable prenatal care and pregnancy support services

In 2012-13, United Way invested in 28 income programs serving nearly 50,000 individuals.

Our goals in Income are to increase the number of adults and families who:

• Earn enough income to meet daily expenses and basic needs like food and housing

• Obtain education or training to develop skills needed to gain and maintain employment that offers a family sustaining wage

• Have access to culturally appropriate relocation and reunificationservicesasimmigrants or refugees

• Have access to high quality, free or low cost legal services

• Save for and build assets to invest in a home or post-secondary education

In 2012-13, United Way invested in 46 education programs serving more than 56,000 children and their families.

Our goals in Education are to increase the number of children who:

• Enter school ready to succeed

• Readproficientlybythirdgrade

• Are on track to be promoted to the next grade level

• Display improved cognitive, social, and/or physical skills

• Graduate from high school on time

• Are prepared for success in college, work and life

Improving people’s Health & Safety

promoting financial Stability & Independence

Helping children & Youth achieve their potential

71050 St. Francis Children's Center73590 Teen Challenge International Wisconsin87600 Wisconsin Lutheran Child & Family Service86025 Wisconsin Right to Life Education Fund88533 Women's Fund of Greater Milwaukee Inc.86022 WRTP/BIG STEP

Donor Designation policy •Giftswillbeforwardedin2015asspecifiedbyyou. •Wewillmakeeveryefforttocontactyouifanyagencyyouchooseisnoteligible,oryourinformationisincompleteorillegible. •UnitedWayofGreaterMilwaukeedoesnotrecommenddesignationsto: •organizationsthatareprimarilycultural,recreational,religious,political,occupation-based,animalwelfareorschools •grant-makingfoundationsandcapitalcampaigns •designationstoorganizationstomeetpreviousorpersonalobligations,suchastuition,pledges,duesorothermembershipcosts •organizationsoutsideofWisconsin(exceptotherUnitedWays)