Faculty-Staff Campaign Contribution Form
☐ YES!, _________________________________________ would like to support the Faculty-Staff Campaign
with a gift to the Chattahoochee Tech Foundation.
My gift will be a monthly payroll deduction that I have selected below. My gift will continue to be
deducted monthly until I cancel my gift, in writing, to the Foundation or terminate employment with
Chattahoochee Technical College.
My gift will be a one-time payroll deduction of $____________ from the next payroll cycle.
My gift will be a one-time gift by cash or check in the amount of $____________. Make checks payable
to: Chattahoochee Tech Foundation
Monthly Payroll Deduction Gift Amount
☐ $100 (=$1,200/year) ☐ $60 (=$720/year) ☐ $40 (=$480/year) ☐ $20 (=$240/year)
☐ $10 (=$120/year) ☐ $5 (=$60/year) ☐ $3 (=$36/year) ☐ $1 (=$12/year)
☐ Other $ ___________________
Gift of $5 per month/$60 per year – receive a T-Shirt. Tell us your T-Shirt size (XS - 5XL):__________
How will your gift make a difference? You decide:
☐ Greatest Area of Need - Unrestricted gifts are used to support the Foundation’s greatest area of need, which may
change from campaign to campaign. These gifts allow the Foundation to provide Emergency Grants for students,
Faculty/Staff Conference Grants, support college-wide needs, and Foundation operations.
☐ Restricted - Please designate my gift to:
☐ Scholarships (if for a specific scholarship, please include name) ________________________________________
☐ Other Foundation Fund ________________________________________________________________________
EMPLOYEE SIGNATURE & CONFIRMATION
By signing/typing my name below and submitting this form to the Chattahoochee Tech Foundation, I affirm that I
understand the terms of my gift agreement.
Signature Line: ______________________________________ Employee Payroll ID: ____________________________
Today’s Date: _______________________________________
Mail or Email Completed Form:
Chattahoochee Tech Foundation, 980 S. Cobb Drive, Marietta, GA 30060, Mail Stop MA-202
Phone: 770-528-4461 Foundation@ChattahoocheeTech.edu
Chattahoochee Tech Foundation (Tax ID 58-1684206) is a 501(c)(3) and your gift is tax-deductible to the extent of the law.
If you have any questions, please call 770-528-4461 or email Foundation@ChattahoocheeTech.edu