UC Impact Payroll Deduction

Payroll Deduction
Enter Donation Amount Here*
Select an Area to Support*
Enter Designation Here*
Please make my gift In Tribute Of/In Memory Of
Appeal Name
Add Another Donation?*

YesNo
Enter Donation Amount Here
Select an Area to Support
Enter Designation Here
Please make my gift In Tribute Of/In Memory Of
Add Another Donation?

YesNo
Enter Donation Amount Here
Select an Area to Support
Enter Designation Here
Please make my gift In Tribute Of/In Memory Of
If you were referred by a #GivingTuesday ambassador, please enter their name below
Gifts of $15 or more, through November 30, are eligible for the #GivingTuesday promotion, would you like to receive the limited-edition 2021 Bearcat ornament?*

YesNo
Donor Information
Employee ID#*
Primary Employer*
Title*
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address Type*

HomeBusiness
Phone Number*

Area CodePhone Number
Phone Type*

HomeBusinessMobile
Permission to Publish

You may publish my/our name(s) in the UC Honor Roll of Donors and other gift publicity.I/we wish to remain anonymous.
If you were referred by a UC Day of Giving Ambassador, please enter their name

First NameLast Name
Payroll Deduction Information
Deducted Amount per Pay Period*
Ex. $50
Number of Pay Periods*
Total Gift Amount
Pay Period in which to start deductions*
Pay-Period*

Bi-WeeklyMonthly
I have an existing payroll deduction pledge. Please start this pledge after the last billing month.
Signature*
By typing your name in the Signature block, you are authorizing your pledge.
Should be Empty:

Payroll Deduction

Donor Information

Payroll Deduction Information