Faculty/Staff Payroll Deduction

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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:

Annual Fund (in support of Tuition Assistance and CEAP)Angel Fund (helping students with needs beyond tuition assistance)
Does your spouse's company match gifts:*

YesNoNot sure
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:*

a set amount per paycheck until I notify you to stopa set amount per paycheck for a given # of payments and a total contribution amount
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, 2022 to June 30, 2023 (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