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Thrive on $5 Employee Giving Campaign

First Name

Last Name

Phone Number

Address

Other

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 giving

I can't remember

How would you like to donate? *

Pay online with credit card (one-time gift)

Payroll deduction (one-time or monthly)

Check

Cash

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

Thrive on $5 - This option will deduct $5 from your paycheck each month

Monthly Payroll Deduction (Custom Amount)

One-Time Payroll Deduction (Custom Amount)

Please provide electronic signature here. By signing, you understand that you are giving approval for District 6 to deduct the amount you have indicated from your paycheck and be donated to the Success Foundation.

How much would you like automatically deducted from your paycheck every month?

How much would you like automatically deducted from your paycheck as a one-time gift?

Checks

I will give my check to my Thrive on $5 Representative

I will mail my check to the Success Foundation: 1025 Ninth Ave. Greeley, 80631

I will give my cash to my Thrive on $5 Building Representative by February 28th

How much would you like to donate? To be eligible for Thrive on $5 Incentives, you must donate at least $60

Thanks for supporting the Success Foundation!

The Success Foundation
Serving Greeley-Evans Schools

1025 Ninth Avenue

Greeley, CO. 80631

970.348.6361 | info[at]d6successfoundation.org

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