Workplace Campaign Participation Survey
Please complete the following so we can best assist you during the 2026-2027 Season
Workplace / Company Name
*
How will your company support United Way of Henry County and Martinsville during the 2026-2027 Campaign Season? Please select all that apply:
*
We will run a paper workplace campaign, encouraging our employees to support UWHCM through an annual donation
We will run an online workplace campaign, encouraging our employees to support UWHCM through an annual donation
We will provide a corporate gift
We will collect general public donations for UWHCM and distribute them to UWHCM
We will host a Special Event Fundraiser where proceeds will benefit UWHCM
We will have a team of volunteers participate in UWHCM Day of Action on Friday, September 18, 2026.
We are not actively participating at this time
Other
Will you serve as a Pacesetter Company? (Companys who run a workplace campaign or pledge a corporate contribution prior to the August 14, 2026, are considered Pacesetter Companies and will be recognized at our Day of Action.
Yes
No
Other
Company Contact Information
This is your company's primary contact for your internal United Way of HCM campaign.
Name
*
First Name
Last Name
Email
*
example@example.com
Primary Direct Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Phone Extension (if applicable)
This is for your direct extension, if applicable
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
Phone Call
Email
SMS / Text
Other
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Facility Information
This information is for internal use. It helps us determine annual campaign pace and performance, as well as estimate the amount of UWHCM physical materials your campaign requires.
CEO / Owner / Supervisor Name
Number of Participating Facilities / Branches
Estimated Number of Employees
Payroll Deduction Start Date
-
Month
-
Day
Year
Estimated Start Date
Workplace Goal (USD)
How would you like for UWHCM to assist you? Select all that apply.
We would like a UWHCM staff member to help promote the cause to our team.
We are interested in company employees volunteering at UWHCM events.
We need help planning a special fundraising event benefiting UWHCM.
We would like virtual resources to distribute to employees.
We would like paper resources to distribute to employees.
Other
Do you have any additional information that you would like to share regarding this year's campaign? Any new ideas you would like to try? Any obstacles that your team may be concerned about this season (employee churn, possible mergers, change in leadership, expansions or hardships)?
Submit
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