Faculty and Staff - Payroll Deduction - Houston Community College Foundation

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Thank you for you support of the 2019 Gulf Coast Advanced Manufacturing Conference. The event registration is now closed. If you are interested in making a gift on behalf of HCC student success, visit hccsfoundation.org/donation.

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Faculty and Staff Payroll Deduction Form

Payroll Deduction Form

1. Your Information:

RequiredYES! I Am All In For HCC Students!*

RequiredFirst Name:*

RequiredMiddle Initial:*

RequiredLast Name:*

RequiredHome Address:*

RequiredCity:*

RequiredState:*

RequiredZip:*

RequiredPlease enter a valid email address with the format youraddress@yourdomain.Email:*

RequiredHCC Campus:*

RequiredPlease enter a 10-digit phone number. You can use hyphens or periods to separate numerals, and you can put the area code in parenthesis.Phone/Campus Extension:*

Employee Information

RequiredEmployee ID:*

RequiredAffiliation:

9 Month Faculty

10.5 Month Faculty

12 Month Faculty

Staff

Chancellor's Executive Council

2. Please Designate My Gift To:

Required

Area of Greatest Need

Bedichek-Orman Fund

Ewen Family Endowed Chairs for Teaching & Learning Excellence Fund

Foundation Scholarship

Joyce Roberta "JR" Miller-Alper Emergency Fund for Adjunct Faculty

Student Basic Needs Fund

Other Scholarship/Operating Fund

RequiredEnter Fund Name (*contact annualgiving@hccsfoundation.org if unsure of fund name)*

3. Split Gift Options (Optional)

Check the box below if you would like to split your gift with a second fund.*

RequiredSplit your gift?*

Required

Area of Greatest Need

Bedichek-Orman Fund

Ewen Family Endowed Chairs for Teaching & Learning Excellence Fund

Foundation Scholarship

Joyce Roberta "JR" Miller-Alper Emergency Fund for Adjunct Faculty

Student Basic Needs Fund

Other Scholarship/Operating Fund

RequiredEnter Fund Name (*contact annualgiving@hccsfoundation.org if unsure of fund name):*

4. Payroll Deduction Options

*Your gift will be deducted per pay period of each month.*

A minimum of $5 per pay period is required for payroll deduction.*

RequiredChoose a payroll deduction option (select amount below):

Start a new payroll deduction (First-Time Sign Up)

Update my current payroll deduction and replace with a new amount

RequiredAmount per pay period:

$20

$15

$10

Enter your own value

This field is required.This value is not unique.*

5. Matching Gifts (Optional)

Does your spouse or partner work for a company that will match your charitable contribution? If so, this is a wonderful way to extend the impact of your donation!*

RequiredMy spouse's / partner's company will match my gift:*

RequiredCompany Name:*

RequiredJoint gift with spouse/partner - Name:*

6. Other (Optional)

RequiredComments:*

In your own words, tell us Why You Love Helping HCC Students.*

RequiredWhy Do You Give:*