Workplace Census Form

Please complete the form, contact the office at 815-232-5184 if you have any questions.

What Campaign Materials will you need?
Speakers are a great way to educate community members about United Way of Northwest Illinois' work. Please indicate if you would like the Executive Director, Campaign Chair, or an Agency Director to speak to your group.
15 + 4 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.