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
   
Other:
   
REQUIRED: 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 July 1, 2021.
   
   
* Signature (type your name in the box below)
   
   
* Today's Date
   
 Choose a date
   
* By Checking ‘I Accept’ you are agreeing to all terms and conditions that have been provided.