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Thrive on $5 2021

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)

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

By submitting this form, you understand that you are providing your official signature and 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 to donate? To be eligible for Thrive on $5 Incentives, you must donate at least $60

Address

1025 Ninth Avenue

Greeley, CO 80631

info[at]d6successfoundation.org

Phone

970.348.6361

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