Fillable Faculty/Staff Giving Form (University of Wisconsin - Parkside)

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Faculty/Staff Giving Form (University of Wisconsin - Parkside)

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Faculty/Staff Giving Form
Interoffice or mail completed form and payment to:
UW-Parkside Foundation
900 Wood Road I P.O. Box 2000
Kenosha, WI 53141-2000
Questions: (262) 595-2404 | development@uwp.edu
New deduction Replace existing deduction
I authorize my gift to be made via payroll deduction. Signature:_________________________________________________
Amount per pay period:
$100.00
$50.00
$25.00
$10.00
Other, $_____
Option 2: One-time Credit Card Gift
Please charge my: MasterCard Visa Discover American Express
Total Gift Amount:_________________ Cardholder’s Name:________________________________________________
Card Number:______________________________________________ Expiration date: ____/____
mm yy
Signature:______________________________________________
Gift Amount:______________
Thank you for your support!
The UW-Parkside Foundation is the designated fundraising agency for UW-Parkside.
Gifts received that are not designated for a specific area will be credited to the
Fund for UW-Parkside (general support). Tax Information: Gifts to the UW-Parkside
Foundation are tax-deductible to the furthest extent of charitable giving laws and regulations.
Faculty/Staff Information
Payroll Deduction Option
One Time Gift
Length of payroll deduction:
Ongoing
1 year
Ongoing payroll deduction will continue as long as you are employed by UW-Parkside, or until
you notify the UW-Parkside Foundation of a change. Thank you for your sustaining support!
Name:_______________________________________________________ EMPL ID:_____________________________________
Work Email:_________________________________________________ Work Phone:____________________________________
Home Mailing Address: _______________________________________________________________________________________
City:__________________________________________ State:_______ Zip:_____________ Home Phone:____________________
Donor name as you wish to be recognized: _______________________________________________________________________
I wish to remain anonymous
Gift Designation
Please designate my gift to: Future Focus Scholarship Fund for UW-Parkside (general support)
Other (Please Specify):______________________________________________________
Payment Options:
Check: Make check or money order payable to: UW-Parkside Foundation
Credit Card: Give online at donate.uwp.edu/give
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FacultyStaff Giving Form (University of Wisconsin - Parkside)

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Completed 24 July 2020

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