Employee Giving CampaignPayroll Deduction Form

Employee Giving Campaign

Payroll Deduction Form

Deductions will begin on either the 15th or the last day of the month, for a specified number of payroll periods or for the foreseeable future.

Employee Name:*

HCCC Email Address:*

Employee College ID #:*

7-digit college wide ID number

Pledge to:*

Please indicate the area which you would like your contribution to support below.

Select

Other:*

(Please indicate the Initiative)

Pledge Anonymously?*

If you pledge anonymously, your name will not be publicized in future communication materiel for all things relating to the Employee Giving Campaign.

Yes

Deductions to Begin On:*

The 15th of the Month

The Last Day of the Month

Please indicate if you would like to give continuously, or for a specified number of paychecks.*

After selecting an option, you will be prompted to enter an amount.

I will give $___ per pay period continuously.

I would like to donate $___ for ___ paychecks.

I will give $___ per pay period continuously.*

Please enter the dollar amount that you would like taken out per paycheck.

Dollar Amount per Paycheck*

Please enter the dollar amount that you would like taken out per paycheck.

Number of Paychecks*

How long would you like to make this donation for?

Example: If you would like to donate for your next 3 paychecks, enter 3 in the field below.

Please allow up to 10 working days for deductions to take effect.

If you have questions, please call (201) 360-4778 or email foundation@hccc.edu.

Thank you for your generosity and for helping HCCC continue to make a difference!

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