Impact Team Volunteer Form

United Way Impact Team Member Information Form

Chad Pitillo / Fall 2023 Impact Team Chair

Your participation, knowledge, and work are very important to the United Way Partner Agencies that serve Pine Bluff, Jefferson County, and Southeast Arkansas. I sincerely hope that you will be able to join other community members in serving on an allocations panel this year.

    Time requirements:
     One half-day for site visits to agencies.
     One half-day for budget review meetings.
     Each is to be held in May.

The Panel Member Information Form is attached. Please complete it as soon as possible and e-mail it back to

Jason Duren / jason_duren@pbreynoldscenter.org or fax it to the United Way office at (870) 534-8005.

Your Panel Chair will contact YOU about your orientation meeting.
Again, thank YOU for your interest in investing your time in such a great way!

Questions: 870-534-2153

First Name

Last Name

Impact Team Member will serve in 2023?

If no, may we contact you in the future?

Buisness/Company

Street Address

City/State/Zip

Telephone Number

Mobile Phone Number

Fax Number

Email Address

Additional Comments or Information

Are you affiliated with any of the United Way Partner Agencies?

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.