Employee Payroll Deduction Form
The payroll deduction option is available for full-time employees only.
Indicates required fields
PERSONAL INFORMATION
First Name:
Last Name:
E-Mail Address:
Department:
J-Number:
Telephone:
Address:
Address (Line 1):
Address (Line 2):
City:
State & Zip Code:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
-
Please select deduction amount
Your gift will be deducted over scheduled pay periods beginning January 1, 2009 through December 31, 2009.
$40 per pay period
$20 per pay period
$15 per pay period
$10 per pay period
$8 per pay period
$5 per pay period
Other amount
Automatic Renewal:
I authorize this gift by payroll deduction to be automatically renewed each year until such time as I terminate employment or notify the Office of Institutional Advancement in writing.
Donor Options
I would like my donation to provide funding for:
Where it is most needed
Student scholarships
Faculty/Staff Development
Technology / Equipment
Library enhancements
Emergency Book Fund
Center for Law and Society
Center for International Understanding
Other
If you prefer to participate in the 2009 Annual Fund in ways other than payroll deduction, please visit
www.ccp.edu/waystogive
.
To make your gift by check or money order, click
here
to download a print and mail donation form.