2023 Our Promise Certification Opt Out Request Form

Post February 7, 2023

This is the Our Promise 2023 Certification Opt Out Request Form. If you do not wish to be automatically applied for Certification in the Our Promise Campaign, please complete this form. You may be contacted during processing in April to confirm your status as an authorized agent for this nonprofit.

If you have any questions, please refer them to opcertification@uwccr.org.

A. GENERAL INFORMATION

Federal Tax ID Number: *

Full Legal Organization Name: *

Physical Address

Street Address: *

No PO Box addresses are accepted in this field.

City: *

State: *

ZIP Code: *

Opt-Out Request Confirmation

By confirming this form, I state the following:

1) I am an official in this nonprofit organization, or I am an authorized agent of this nonprofit, and have the proper authority to submit this request on behalf of the listed nonprofit.

2) This nonprofit does not wish to be listed as “Certified” in the 2023 Our Promise Campaign. I recognize that this does not stop or modify any current payments to my nonprofit from the Our Promise Campaign.

Name: *

Title: *

Date: *

Signature: *

By typing your name in the box above, you are providing a digital signature that affirms the accuracy of the information provided within this application.

Email Address: *

Phone Number: *

By confirming this form, I state the following:

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2023 Our Promise Certification Opt Out Request Form

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