You must have JavaScript enabled to use this form. Pledge Card - Mason City Community School District Your Information Company Name Name Email Address Phone Street Address City State Zip Code Donation Method Preferred Donation Method Payroll Deduction Check Cash Bill Me Credit Card Payroll Deduction Contribution Amount Per Pay Period $5 $10 $20 $25 $50 Other… Please enter the NUMBER only $ Number of Pay Periods for Donation Monthly - 12 pay periods Check Donation Amount of Check $ Make checks payable to United Way of North Central Iowa. Please give the check to your Campaign Coordinator within 24 hours of this pledge. Cash Donation Amount of Cash $ Please give your cash donation to your Campaign Coordinator within 24 hours of this pledge. Bill Me Details Frequency of Invoice One Time Quarterly Monthly Amount of EACH direct bill $ Dolly Parton Imagination Library In addition to my annual gift, would you like to give the gift of reading to a child for the cost of $31/yr.? Yes No Please enter the number of children you wish to sponsor Each child costs $31 to sponsor Total Annual Contribution TOTAL: $ 0 Designations I would like to designate my gift Designate to a United Way Initiative Designate to a 501(c)3 in serving Cerro Gordo, Floyd, Franklin, Hancock, Kossuth, Mitchell, Winnebago or Worth Counties. United Way Initiatives United Way Community Impact Fund The most powerful way to invest your contribution, supporting programs and initiatives such as local partner programs, 2-1-1, and SingleCare Education Ensuring children and youth achieve their potential through education. Financial Stability Preparing individuals and families to become financially stable and independent. Health Helping individuals achieve maximum physical, emotional and mental health and safety. Women United Designate $250 to become a member of Women United, a group of philanthropic women focused on ensuring healthy families with access to opportunities. Designation amount for Community Impact Fund $ Designation amount for Education $ Designation amount for Financial Stability $ Designation amount for Health $ Designation amount for Women United $ Designated Agency Agency Name Designation Amount Email Phone Address Address 2 City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Zip Code Unless otherwise designated, your donation will be included into the Community Impact Fund. Please note: a $50.00 minimum donation per designated agency and there is a limit of THREE designations per contribution. Agency must be a 501(c)3 providing service in our 8-county region. Donations that do not meet the minimum requirement will be designated to the Community Impact Fund. Interested in Volunteering? Sign Up Today! I would like more information about serving on a Community Impact Team. I would like more information on serving on the Board of United Way of North Central Iowa. I would like to participate and help out at special community events. Other… Enter other… Agreement My signature below, confirms my pledge as stated above. Signature Sign above Credit Card Donation Amount of Contribution $ What type of donation is this? One-Time Recurring Recurring Frequency Monthly Quarterly I am willing to cover the 4% online processing fee Would you like a portion of your donation to support the Dolly Parton Imagination Library? Yes No How much of your donation would you like to designate to the Dolly Parton Imagination Library ($31 sponsors a child for a year)? Payment Details Leave this field blank Red Arches
