Speaker or Agency Tour RequestA donation to the Heart of Illinois United Way changes people’s lives, but sometimes it is hard for donors to connect how their gift makes a difference. Hosting a speaker or taking an agency tour can inspire your employees during your workplace fundraising campaign. The Heart of Illinois United Way can help you arrange your next speaker or tour. Please complete the form below. Requests need to be submitted a minimum of two weeks prior to the date you wish to host a speaker or take a tour. Please contact *protected email* if you have any further questions.Organization InformationOrganization Name(Required)Department / Division / BranchOrganization Contact Name(Required) First Last Phone(Required)Phone ExtensionEmail(Required) Organization Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If you would like to request both a speaker and an agency tour, or request multiple speakers or tours, a separate form will need to be submitted for each request.Requesting(Required) Speaker Agency TourSpeaker Request Additional InformationThe suggested meeting agenda for hosting a speaker should include a welcome message/campaign endorsement, *United Way staff speaker, optional agency guest speaker, and closing remarks.(*If you are hosting an agency speaker, a Heart of Illinois United Way staff member will also attend to provide brief introduction.)Speaker Type(Required) We would like to host a Heart of Illinois United Way Speaker We would like to host a Heart of Illinois United Way Partner Agency SpeakerDate Speaker is Needed(Required) MM slash DD slash YYYY To select dates in upcoming months, please navigate to that month using the top arrows or dropdown menu in the date picker. Do not try to select “grayed out” dates.Time Speaker is Needed(Required) Hours: Minutes AMPM AM/PMSpeakers will be advised to arrive a minimum of 15 minutes prior to the time listedSpeakers will be joining the meeting(Required) Virtually In-PersonAddress/Location for In-Person Speaking Engagement(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please share specific parking, entrance, sign-in, safety procedures, etc.(Required)Please share contact information for someone a speaker can call at the time of meeting if they encounter an issue or need further directions.Contact Name(Required) First Last Contact Phone(Required)Contact Phone ExtensionContact Email(Required) If requesting a Partner Agency Speaker, please select three (3) options(Required) Alzheimer’s Association Illinois Chapter American Red Cross – Central Illinois Chapter Big Brothers Big Sisters, Heart of Illinois Boy Scouts of America – W.D. Boyce Council Boys & Girls Clubs of Greater Peoria, Inc. CASA of the Tenth Judicial Circuit The Center for Prevention of Abuse The Center for Youth & Family Solutions Central Illinois FRIENDS of PWA, Inc. Children’s Home Association of Illinois Community Workshop & Training Center, Inc. Crittenton Centers Dream Center Peoria Easterseals Central Illinois EP!C FamilyCore Freedom House G.W. Carver Community Center Girl Scouts of Central Illinois Goodwill Industries of Central Illinois Greater Peoria Family YMCA Habitat for Humanity – Greater Peoria Area Heartland Health Services Hult Center for Healthy Living Junior Achievement of Central Illinois Lutheran Social Services of Illinois METEC Resource Center Midwest Food Bank Neighborhood House Association OSF HealthCare Children’s Hospital of Illinois Pearce Community Center Peoria Friendship House of Christian Service Peoria Promise Phoenix Community Development Services Prairie State Legal Services, Inc. Tazewell County Resource Centers, Inc. The Salvation Army Tri-County Peoria Urban League, Inc. UnityPlace Human Service Center UnityPlace Tazwood Center for Wellness We Care, a division of TCRC, Inc. Youth Service Bureau of Illinois Valley YWCA of PekinEstimated Audience Size(Required)Please enter a number greater than or equal to 0.Speaker Time Limit, in Minutes(Required)Please enter a number from 5 to 15.Note(s)Thank you for requesting a speaker.You should receive confirmation email for this request form once you click submit.A Heart of Illinois United Way staff member will follow-up with you within three (3) business days.Please call us at 309-674-5181 if you have any questions.Agency Tour Request Additional InformationDate of Requested Tour(Required) MM slash DD slash YYYY To select dates in upcoming months, please navigate to that month using the top arrows or dropdown menu in the date picker. Do not try to select “grayed out” dates.Time of Requested Tour(Required) Hours: Minutes AMPM AM/PMPlease select three (3) options for a Partner Agency Tour.(Required) Alzheimer’s Association Illinois Chapter American Red Cross – Central Illinois Chapter Big Brothers Big Sisters, Heart of Illinois Boy Scouts of America – W.D. Boyce Council Boys & Girls Clubs of Greater Peoria, Inc. CASA of the Tenth Judicial Circuit The Center for Prevention of Abuse The Center for Youth & Family Solutions Central Illinois FRIENDS of PWA, Inc. Children’s Home Association of Illinois Community Workshop & Training Center, Inc. Crittenton Centers Dream Center Peoria Easterseals Central Illinois EP!C FamilyCore Freedom House G.W. Carver Community Center Girl Scouts of Central Illinois Goodwill Industries of Central Illinois Greater Peoria Family YMCA Habitat for Humanity – Greater Peoria Area Heartland Health Services Hult Center for Healthy Living Junior Achievement of Central Illinois Lutheran Social Services of Illinois METEC Resource Center Midwest Food Bank Neighborhood House Association OSF HealthCare Children’s Hospital of Illinois Pearce Community Center Peoria Friendship House of Christian Service Peoria Promise Phoenix Community Development Services Prairie State Legal Services, Inc. Tazewell County Resource Centers, Inc. The Salvation Army Tri-County Peoria Urban League, Inc. Trillium Place Human Service Center Trillium Place Tazwood Center for Wellness We Care, a division of TCRC, Inc. Youth Service Bureau of Illinois Valley YWCA of PekinEstimated Tour Group Size(Required)Please enter a number greater than or equal to 0.Note(s)Thank you for requesting a tour.You should receive confirmation email for this request form once you click submit.A Heart of Illinois United Way staff member will follow-up with you within three (3) business days.Please call us at 309-674-5181 if you have any questions.PhoneThis field is for validation purposes and should be left unchanged.