Your organization may have received designations from the United Way of Brevard Community Campaign. In order to receive these funds you must complete the Patriot Act Compliance Form. This is an annual federal requirement. Failure to complete this form or qualify as a 501(c)3 organization in good standing with the IRS will result in the release of your funds back to United Way of Brevard for redistribution.
Your organization has received designations from the 2017 United Way of Brevard Community Campaign. This form must be completed to receive designation payments.
1.) Organization Information
Electronic Fund Transfer (EFT) payments are made quarterly. If your organization does not enroll in EFT you will only receive one payment (paper check) in April of 2019 when the 2017 campaign payout cycle is complete. If you are not sure if your organization is currently enrolled or wish to enroll in the EFT payment program contact Debra Stull at United Way of Brevard at firstname.lastname@example.org or by calling 321.631.2743. Select donor directed payments do not apply.
3.) Patriot Act Certification
Items marked with an asterisk(*) are required. Please review your responses and make sure you have answered every question with an asterisk (*).