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2015 UNITED WAY DONOR CHOICE PROGRAM RECERTIFICATION

2015 UNITED WAY DONOR CHOICE PROGRAM RECERTIFICATION

The United Way of Buffalo & Erie County Donor Choice (DC) Program [General Campaign] allows our donors to designate to a currently eligible non-for-profit, 501(c)(3) Health or Human Service charity. Selected organizations are notified and REQUIRED to complete this form in order to receive potential donor contributions. See instructions below for ONLINE completion only.

PLEASE READ CAREFULLY AND COMPLETE IN FULL BEFORE SUBMITTING.
Each separate line (field) requires specific, important information that will be loaded into our database.

1. Click on the link: "fill it out in Google Forms" in the email (memo) you received from us.
2. Most fields are required (*). For fields that are not required and NOT APPLICABLE to your agency, LEAVE BLANK.
3. Boxes outlined in RED contain ERRORS and will show an error message under field -- CORRECT before submitting.
4. You may want to PRINT A COPY of completed form for your records.
5. BE SURE TO CLICK THE BLUE "SUBMIT" BUTTON AFTER COMPLETION - we are NOT responsible for incomplete or late submissions. After you click Submit, you will see "Your response has been recorded."
6. If your agency is located within the eight (8) counties of WNY, you may want to check if you are registered with "2-1-1 WNY", a public service that provides information on health and human services.

    Please select NO or YES
    This is a required question
    Format with dash: XX-XXXXXXX
    This is a required question
    This is a required question
    This is a required question
    225 characters max
    This is a required question
    Use Mailing Address fields for PO Box
    This is a required question
    This is a required question
    Enter 2-letter State abbreviation
    This is a required question
    5-digit only
    This is a required question
    This is a required question
    This is a required question
    Enter 2-letter State abbreviation
    This is a required question
    5-digit only
    This is a required question
    Enter County
    This is a required question
    10-digit phone number with dashes (no parentheses)
    This is a required question
    This is a required question
    Enter general business email address
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    Enter main contact email
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    Enter CEO email
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    Enter CVO email
    This is a required question
    This is a required question
    To certify to the above conditions, check all boxes
    This is a required question
    This is a required question
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