2026 General Campaign Donor Choice Agency Certification

United Way's General Campaign primarily raises funds to support our core Impact Areas: Healthy Community, Youth Opportunity, Financial Security, and Community Resiliency. As a courtesy alternative giving option, the United Way Donor Choice Program (DCP) allows individuals to direct contributions to other qualified 501(c)(3) organizations. Donor-designated contributions reflect independent donor selections and do not establish an official United Way agency affiliation. Organizations must complete this form annually to be considered for donor-designated contributions.

Important: This form applies only to United Way of Buffalo & Erie County's General Campaign. It does not satisfy qualification, certification, or compliance requirements for the NYS SEFA, State Employees Federated Appeal, or any other fundraising campaign.

Before You Begin:

Allow approximately 10-15 minutes to complete the form.
Have your organization's EIN and current contact information available.
Helpful tips are provided throughout the form.
A confirmation email will be sent after successful submission.

Instructions:

Submit only one form per organization/location. Before submitting, please confirm that another staff member has not already completed the form for the current campaign year.
Use standard capitalization. Do not enter responses in ALL CAPS or all lowercase letters.
Complete all required fields. Required fields are marked with a red asterisk (*). Leave optional fields blank unless they apply to your organization.
Do not copy and paste from websites. Hidden formatting, hyperlinks, and HTML code may cause submission errors.
Review all information carefully. Please verify all entries for accuracy before submitting.

Respondent's Email Address

A confirmation will be sent to this email upon successful completion (email will be from noreply@jotformsign.com)

Vendor #

This agency's Vendor ID can be found at the top of your check stub (directly under "Payee"). LEAVE BLANK if unknown.

Organization EIN (Employer Identification Number)

9-digit EIN used for 501(c)(3) bearer in IRS records

Nonprofit Name (Legal Name)

Primary name by which this organization is listed in IRS records

Also Known As (AKA) Name

Abbreviation, acronym, AKA, dba, or, if you are NOT the actual EIN holder. Leave blank if N/A.

Has your agency's Street or Mailing address recently changed?

Main Address

Street Address

CityState (abbreviation)Zip Code (5-digit)Country

Do you have a separate Mailing Address, such as a PO Box?

Mailing Address [if different from street or main address]

Mailing Address

CityState (abbreviation)Zip Code (5-digit)Country

Does this agency provide a direct Health or Human Service (HHS) as a main part of their Mission?

Mission Statement

Main purpose of this charity's existence [275-character max].0/275

Organization Website

Alternate Organization Website

Use this field if you want to add a second website, Facebook page, etc. LEAVE BLANK IF N/A.

Business Phone

Main business number w/ area codeFormat: (000) 000-0000.

General Email Address

A "general" email address that is regularly monitored, and will not change due to employee turnover, etc. If you do not have a generic email, please enter your preferred contact email for this agency

Primary Contact's Full Name

Person responsible for donations and correspondence

Primary Contact's Work Title

Primary Contact's Email

Important business emails may be sent to this email

Chief Executive Officer's Full Name

Lead person in charge of this local organization

Chief Executive Officer's Work Title

Chief Executive Officer's Email

Board Leadership Full Name

Unpaid lead board member's name

Board Leadership Title

Lead board member's title within THIS charity organization (Board Chair, Treasurer, etc.)

Board Leadership Contact Email

For the event we need to send an email to this contact (LEAVE BLANK if none)

Board Leadership Employer

CVO employer, if applicable (LEAVE BLANK if none)

Charitable Status & Anti-terrorism Conditions (please read carefully)

Funds received through United Way of Buffalo & Erie County and/or their donors are used for charitable purposes only.
We are currently eligible to receive tax-deductible contributions under section 501(c)(3) of the Internal Revenue Code (IRC) and continue to maintain a good standing with the IRS and State Charities Bureau or regulators. Our 990 or 990-N is current, if required to file, and our charitable status is currently valid.
In compliance with U.S. counterterrorism and economic sanctions laws, our organization affirms that it does not and will not knowingly provide financial or material support to any individual or entity involved in terrorism or subject to applicable sanctions, and that all funds received from United Way and their donors will be used in accordance with these laws, statutes, and executive orders.

CHARITABLE STATUS & ANTI-TERRORISM COMPLIANCE

Signatory Full Name

Individual who is certifying on behalf of this agency

Date Signed

Optional

Important info directly pertaining to this agency, if any. 0/250

Please review all details before submitting this form.

Before finalizing this, please ensure you have entered a complete main and/or mailing address. Once submitted, you will promptly receive a confirmation email from noreply@jotformsign.com. We appreciate your time and cooperation in helping us keep this process streamlined. Thank you!