Bellefontaine City Schools 2023 Pledge Form

YES! I will join the fight for the health, education, and

financial stability of every person in our community!

I will make the following payroll deduction pledge.

CAMPAIGN INCENTIVES

* All donors receive 1 Jeans Pass for every $5 donated. (Maximum of 25 passes)

* All donors receive 1 raffle ticket for every $10 donated for Gift Card drawings.

* All buildings with 70% participation will receive a snack/treat for all staff.

* How much do you wish to donate per pay in 2023-24? (Deductions start in October and run for 22 pays.)

$20 / pay for a total gift of $440.

$15 / pay for a total gift of $330.

$10 / pay for a total gift of $220.

$5 / pay for a total gift of $110.

OTHER / PAY. Click OTHER below. Type "PER PAY" and the weekly amount to deduct.

1-TIME DEDUCTION. Click OTHER below. Type "1-time," then total gift.

Other

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If you wish to make your gift via Credit Card, click here.

If you wish to make a cash or check gift, DO NOT FILL OUT THIS FORM.

Give your cash/check gift AND a hard copy form

directly to your United Way Building Representative.

OPTIONAL: Do you wish to designate your gift to one or more specific United Way programs? If so, type the name(s) of the program below. For a list of United Way-supported programs, click the county of your choice below.

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CLICK HERE TO SEE A FULL UNITED WAY PROGRAM DIRECTORY.

* First Name

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* Last Name

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* E-mail

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* Address

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* City

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* Zip Code

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In which building do you work?

Elementary

Intermediate

Middle School

High School

Central Ohio

Transportation / Maintenance

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