Faculty/Staff Payroll Deduction

Megan: This is an active form. Don't delete.
Faculty/Staff Donation

Setting up payroll deduction through your BCHS payroll for your donation
BCHS Employee Name

First NameLast Name
Your Email
example@example.com
Please direct my gift to:
Does your spouse's company match gifts:
Spouse's Name
Spouse's Company/Employer
PAYMENT OPTIONS:

Please setup a payroll deduction for me in one of the following methods:
Choose one type of setup:
Enter Amount Per Paycheck (until I tell you to stop)
Enter Amount per paycheck (do not enter $ sign)
Enter number of payments
Your Total Contribution Will Be
Sample of payroll deduction for July 1, 2026 to June 30, 2027 (26 pay periods)
- $1/paycheck = $26/year
- $5/paycheck = $130/year
- $10/paycheck = $260/year
- $20/paycheck = $520/year
- $50/paycheck = $1300/year
Comments:
Signature - use your mouse or finger to sign
Date Signed

MonthDayYear
Date
Should be Empty:

Faculty/Staff Donation