Employee Payroll Deduction Form

Laurel Ridge employees, please complete and submit this online form to donate to the Foundation through payroll deduction. Contact Beverly Steele if you have any questions or need assistance.

Thank you for your kind donations to benefit our students!

Your Information:
Your Name:*
Prefix First Last
Spouse's Name:
Optional
First Last
Your Email:*
Your Phone Number:*
Home Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Birthday:
MM slash DD slash YYYY
Please choose your primary Laurel Ridge location:*
Contribution Options:
I would like to contribute through payroll deduction. Please deduct:*
- $3 ($72 annually)
- $5 ($120 annually)
- $10 ($240 annually)
- $20 ($420 annually)
- Provide a custom contribution amountOther contribution amount
Please indicate how you like your contribution to be designated. You may designate one fund or split your donation among more than one fund or scholarship. Please consider supporting the Cornerstone Fund – our annual fund.*
Click the plus icon to the right to add more contribution designations.
Fund Amount Per Pay Period
Additional Comments / Notes regarding your donation:
Public Recognition:
May the college publicly acknowledge this commitment? (By checking “yes,” you are authorizing the Foundation to list you as a donor in Foundation publications, such as the Foundation annual report.)*
- Yes, the college may publicly acknowledge this commitment
- No, the college may not publicly acknowledge this commitment
Agreement:
By initialing below and submitting this form, I attest that the information on this form is correct and am authorizing the amounts indicated above to be donated to the Laurel Ridge Educational Foundation via payroll deduction.
Initials:*
Please initial below to accept the statement outlined above.
Phone
This field is for validation purposes and should be left unchanged.

Fund	Amount Per Pay Period

Employee Payroll Deduction Form

Your Information:

Contribution Options:

Public Recognition:

Agreement: