Caregivers Action Fund (SEIU COPE) Donation Form

Yes! I want to hold politicians accountable to working families!

The Caregivers Action Fund (SEIU COPE) program is vital to keeping the In Home Supportive Services program alive. The government directly funds our program, so we need political power to advocate for ourselves and our clients and to keep winning strong contracts.

Because of members’ investments in the Caregivers Action Fund (SEIU COPE), we’ve been able to win huge increases in our state minimum wage, increase state funding for in Home Supportive Services, and elect representatives to Congress that are fighting to expand Medicaid and make quality affordable care available to all Americans.***Full program description and terms are listed below.

My signature shows that I agree with the terms above.

Contributions or gifts to Caregivers Action Fund (SEIU COPE) are not tax deductible as charitable contributions.

CAREGIVERS ACTION FUND AUTHORIZATION

Yes, I want to join fellow caregivers in taking action to elect champions for Long Term Care workers and our communities and hold them accountable to act in the best interest of caregivers and those who receive our care.

I hereby authorize the Office of the State Controller of California to withhold the indicated amount per month to forward to SEIU Local 2015 as a contribution to the Caregivers Action Fund. Caregivers Action Fund is acting as a collecting agent for SEIU COPE.

This authorization is made voluntarily based on my specific understanding that; (1) I am not required to sign this form or make voluntary contributions to the Caregivers Action Fund (SEIU COPE) as a condition of my employment or membership in the union; (2) I may refuse to contribute without reprisal; (3) under law, only union members and executive/administrative staff who are U.S. Citizens or lawful permanent residents are eligible to contribute to the Caregivers Action Fund (SEIU COPE); (4) the contribution amounts on this form are merely suggestions, and I may contribute more or less by this or other means without fear of disadvantage from SEIU Local 2015 or my employer; (5) Caregivers Action Fund (SEIU COPE) uses the money it receives for political purposes – including, but not limited to, making contributions to and expenditures on behalf of candidates for federal, state, and local offices – and addressing political issues of public importance.

This authorization shall remain in effect until revoked by me in writing to SEIU Local 2015 via U.S. mail or other permitted method.