Columbia Community Service - Donation by Payroll Pledge

Employee Information [fields marked with * are required]

UNI | Employee ID: *

Title: *

First Name: *

Last Name: *

Affiliate: *

Division: *

Special Events: *

Status: *

Donation Information

Join us! Be recognized as a CCS...

Leader: Give $5,000 and above
Influencer: Give $2,500-$4,999
Sustainer: Give $1,000-$2,499
Partner: Give $500-$999
CCS Friend: Give $240-$499
CCS Supporter: Give up to $240

I am paid: *

Donation Amount: *

Please note: The amount listed in the donation box will be deducted from EACH paycheck. Payroll pledge donations received after January 1 will commence with retroactive deductions, unless otherwise requested.

Pledge Period: *

Please check this box if you would like your payroll pledge to be made ONLY for the current campaign year. You will have the opportunity to contribute by payroll pledge or cash in the next Campaign. Deductions will commence on January 1, 2019 and end December 31, 2019.

Please check this box if you would like your payroll pledge for the current campaign year automatically rolled over into all future Campaigns as a payroll deduction during the remainder of the course of your employment.

Donation Notes:

University Address

Address 1:

Address 2:

Preferred Email Address: *

State:

Postal Code:

E-Signature: *

Yes

E-Signature. I understand that by selecting the "yes" option, I authorize the payroll department to deduct my paycheck by the amount listed above.

Email for receipt: *

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