Employee Giving Form - Payroll Gifts 

Questions that require an answer are marked with  *
* First Name
* Last Name
* Employee #
* Phone Type
* Phone Number
* Email
* Ways to Give
SELECT ONE: Automatic Payroll Deduction Amount per pay period
One-Time Payroll Deduction Amount (minimum of $25)
PTO Donation - One-Time (Must have minimum 80hrs in PTO account)
* I want my gift to support:
Unless designated as a one time gift, all automatic payroll deductions will begin on November 1, 2022.

T-shirts will be provided to all donors who give a total of $500 or more.
* What is your T-Shirt size?
* Preferred gender for t-shirt
* Signature (type your name in the box below)
* Today's Date
 Please pick Today's Date as a part of your acceptance of the terms.
* By Checking ‘I Accept’ you are agreeing to all terms and conditions that have been provided.