Support Caring - Change Amount

Support Caring - Change Amount

Carolina Caring Foundation
Name

PrefixFirst NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@carolinacaring.org
Department fill in blank Preferred Telephone # fill in blank
Option 1. I authorize Carolina Caring Foundation to deduct the following amount per pay period (based on 26 pay periods)

$40.00 per payroll ($1,040/yr)$25 per payroll ($650/yr)$10 per payroll ($260/yr)$5 per payroll ($130/yr)Other Amount
Option 2: I authorize a one time payroll deduction to Carolina Caring Foundation for the following amount:
$
Designate Your Gift (gift will be equally spread over selections unless otherwise stated below)

Employee Assistance - A fund for employees facing financial hardshipLife Enrichment - Supports patient wishes and assists with unmet needs not related to direct medical servicesLinda Clarke Scholarship - Offers financial assistance to employees improving their work-related skills through higher educationCardinal Kids - Allows us to provide compassionate care to children and families facing chronic life limiting illnessesPet Peace of Mind - Helps keep patients and pets together by providing support for those no longer physically or financially able to care for their petsThe Greatest Need - A gift to the Foundation will be used where it is most needed, for patient care, programs and services that are not covered by any other means
Any additional comments:
Please sign below to authorize payroll deduction:

Clear
If you are interested in making a one-time credit card donation please visit www.carolinacaring.org/give

THANK YOU FOR YOUR SUPPORT!

Your donation is tax deductible. Payroll deduction donations will renew automatically on an annual basis unless changed by the employee. You may change or stop payroll deduction at any time with a written request to the Foundation, Human Resources or submission of a new donation form.
For more information, please contact the Carolina Caring Foundation Department 828.466.0466.
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