Pledge Form JCSC

Jennings County United Way Pledge Form

- Jennings County Schools Employees
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number

Area CodePhone Number
I pledge*
YesNo
JCUW Impact Area (Crisis, Education, Financial Stability, Health, Covid Relief FundUnited Way and another nonprofit100% to another nonprofit
Crisis / Basic needsEducationFInancial StabilityHealthCOVID-19 Relief Fund
50% to United Way 50% designated to:
Name of 501(c) Non-profit Agency
Address of 501(c)3

Street Address

Street Address Line 2

CityState

Zip Code
100% designated to:
Name of 501(c) Non-profit Agency
Address of 501(c)3

Street Address

Street Address Line 2

CityState

Zip Code
yesno
Signature*

Clear
Thank you for your contribution.
Today's Date

MonthDayYear
Date
Should be Empty:

Jennings County United Way Pledge Form