2017-18 P@W Payroll - CHI Health Foundation

If you do not wish to have your name listed in any donor recognition media, please select the Anonymous box below.

I would like my tax-deductible gift to be (select one):

I would like to continue my pledge for additional years:

Please select your method of payment:

Please deduct the following amount from my 01/12/18 paycheck:

Please deduct the following amount each paycheck, for 26 pay periods, beginning in January 2018:

I would like to be a member of the "Hour" club and donate one hour of my pay (or more), to be deducted from my 01/12/18 paycheck.

I would like to be a member of the "Hour" club and donate one hour of my pay (or more) per paycheck, for 26 pay periods, beginning in January 2018.

I would like to donate one hour of PTO (or more), to be deducted from my 01/12/18 paycheck.

I would like to donate one hour of PTO (or more) per paycheck, for 26 pay periods, beginning in January 2018.

Please select the area/program you would like your gift to support. PLEASE NOTE: In order to select more than one fund, you must contribute at least $10 per paycheck to each fund. Your total donation will be divided equally between all funds selected.

*Sexual Assault Nurse Examiner

Please enter the date and your full name below, then click the Submit button to finalize your donation.

2018 Philanthropy@Work