Fillable Foundation-payroll-deduction - Employee Payroll Deducation Form - Template

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Foundation-payroll-deduction - Employee Payroll Deducation Form - Template

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

EmployeeInformation



Name:_____________ _________________________________________________________________

Department:_______________ _________________________Phone:__________________________

Mailingaddress:___________________________________________________________________ ____

Preferredemailaddress:________________________________________________________ ________

Iwouldlikemygifttoremainanonymous



PledgeAmountandPaymentOptions



 Iwouldliketodonate$________perpay‐periodtotheEmployeeGivingCampaignand

authorizethePayrollOfficetobeginmakingdeductionsonthefirstpayrollfollowing__/__/__

‐OR‐

 Pleaseacceptmyone‐timegiftof:$___ __________________

Paymenttype*:che ckcashor

creditcard(

inpersonatCCCFoundationOffice,LoneTree

campusoron‐line)



AlldonationsmadethroughtheEmployeeGivingCampaignareadministeredbytheCCCFoundationwhichisa501(c)3taxexempt

organization.Yourcontributionsaretaxdeductibletothefullextentallowedbylaw.Consultyourtaxprofessionalforadviceonyourpersonal

taxsituation.Payrolldeductionsaremadeon

apost‐taxbasis.



Signature:______________________________________Date:______________________

Yoursignatureisrequiredtoauthorizepayrolldeductions.



DesignateYourGifttotheCCCFoundation(Optional)



WhenyousupporttheCCCFoundation,youaresupportingthemissionandconnectingtothelegacyofthe

College.Belowaresomeexamplesofwaysthefourimpactareas**helpstudents.Pleasecheckthefundwhere

youwouldliketodesignateyourcontribution.



Automaticpayrolldeductionscanonlybedesignatedintooneofthecategorieslistedbelow.Ifyouwishyourgift

tofocusonanareanotlistedbelow,contacttheCCCFoundationstafftodiscussotherpossibilities.

scott.talboom@coconino.eduor928‐226‐4335.



CCCGreatestNeeds CCC2NAUPresident’s

Scholarship

CCCEmployeeFunded

Scholarships

Examplesofuse:



♦ Urgent and immediate needs of

CCC and its students



Examplesofuse:



♦ Endowed scholarships for

CCC2NAU students.



Examplesofuse:

Staff and faculty funded

scholarships:

 General

 Veterans

 Theresa Alvarado



**TheimpactareaslistedaboveareoverseenbytheCCCFoundationBoardofDirectorsandCCCstafftoensure

thatfundsareusedinaccordancewithdonorwishes.Ifthereisaspecificfundorareathatyouwouldliketo

support,contacttheOfficeofInstitutionalAdvancementat928

‐226‐4335todiscussyourgift.



Pleasereturnthiscompletedformto:

CCCFoundation,OfficeofInstitutionalAdvancement,2800S.LoneTreeRoad,Flagstaff,AZ86005



TheImpactofYourGift



PayrollDeductionover24Pay‐Periods  CurrentStudentExpenses(approximate)



$perpayperiod Totalgiving1‐Year  Cost ExpenseItem

$2 $48$87 OneCreditHour

$3 $72$120 TextBook

$5 $120$265 Tuitionforoneclass

$10 $240$1350 Tuitionforonesemester

$15 $360$2700 Tuitionforoneyear

$20 $480$3500 Tuitionandbooksforoneyear



Youmaychooseanyamounttocontributeperpay‐period.Thetableisforillustrativepurposesonly.



CCCFoundationMissionandVision



ThemissionoftheCoconinoCommunityCollegeFoundationistopromotethepurposeand

goalsofCoconinoCommunityCollegeandtoenhancetheopportunitiesofCoconinoCounty

residents.



ThevisionoftheCoconinoCommunityCollegeFoundationis tobeaself‐sustainingentitythat

providessupportandleadershipthroughcommunityrelations,advocacyandfundraisingfor

CoconinoCommunityCollege.



CCCCoreValues



♦ People ♦ Learning and Growth ♦ Community ♦ Ethics

♦ Quality ♦ Sustainability ♦ Respect

Recognition

May we recognize you in CCC Foundation donor lists and publications  Yes /  No

How would you prefer your name to appear?

Examples: Mr. & Mrs. Smith 

Ron & Jane Smith 

Pat Jones & Taylor Hughes 

(alphabetization based on the last name listed first)

Please print

Thank you for showing your support for students and the CCC community.

The Office of Institutional Advancement

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Completed 18 November 2019

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