Thrive on $5 Giving Campaign

Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
District 6 School or Department*
Have you given previously, or are you currently giving to the Success Foundation Serving Greeley-Evans Schools?*

Yes, but I would like to give again or change my current givingNoI can't remember
How would you like to donate?*

Pay online with credit card (one-time gift)Payroll deduction (one-time or monthly)CheckCash

Donation Amount

USDDescription

Don't forget to complete this form by pressing Next button below and then Submit button on next screen.

Payroll Deduction - Please choose one of the three payroll deduction options:*

Thrive On $5 - This option will deduct $5 from your paycheck each monthMonthly Payroll Deduction (Custom Amount)One-Time Payroll Deduction (Custom Amount)

I authorize Thrive on $5 payroll deduction of $5 per month from my paycheck each month.*

Powered by Jotform SignClear

Will you be giving a Monthly or One-Time Payroll Deduction (Custom Amount)? - SELECT ONE*

I would like this automatic deduction to take place EVERY MONTH from my paycheckI would like this automatic deduction to take place as a ONE-TIME GIFT from my paycheck
Please list the dollar amount of the Payroll Deduction (Custom Amount) *
I authorize the deduction from my paycheck that matches the details above. Please Sign:*

Powered by Jotform SignClear

How much would you like to donate? An annual donation of $60 makes you an official Thrive on $5 donor!*
How will you submit your check?*

I will give my check to my Thrive On $5 RepresentativeI will mail my check to the Success Foundation, 1025 Ninth Avenue, Greeley, CO 80631

How much would you like to donate? An annual donation of $60 makes you an official Thrive on $5 donor!*
How will you submit your cash?*

I will give cash donation to my Thrive On $5 Representative by February 28th

Thank you for submitting a gift for the Thrive on $5 campaign.

If you have any questions, please reach out to info@d6successfoundation.org
Should be Empty: