Impact Team Volunteer Form

United Way Impact Team Member Information Form

Donna Dial / Fall 2024 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

Tonya Stephens / tonya_stephens@pbreynoldscenter.org

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?

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