Ways to Give

Employee Campaign Pledge Form

Your participation in the Employee Giving Campaign means so much to us. As the campaign progresses, we look forward to sharing what your support has made possible. If you are a Saint Agnes or Trinity Health Colleague, please fill out the Pledge Form below. In the Comment section, please remember to put the name of your Supervisor and Department name and also any different size needs for other items.

If you are a Provider or SAMP Colleague, please go back and visit the other link that will direct you to the credit card monthly deduction form.

Donation deductions will begin with the pay period ending September 7th and will run for 26 pay periods.

Donation Information

Amount:

$5.00 Per Pay Period ___

$130.00

$10.00 Per Pay Period ___

$260.00

$20.00 Per Pay Period ___

$520.00

$30.00 Per Pay Period ___

$780.00

$40.00 Per Pay Period ___

$1,040.00

$50.00 Per Pay Period___

$1,300.00

Other

Additional Information

Comments:

Fill in Saint Agnes or Trinity Health Colleague:

Shirt Size- If applicable:

Workday Employee ID:

Billing Information

Title:

First name:

Last name:

Country:

Address:

City:

State:

ZIP:

Phone:

Email:

Confirm Email:

Ways to Give

Employee Campaign Pledge Form

Donation Form