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Employee Payroll Pledge Form

Please use this secure form to submit a payroll deduction request. We respect your privacy and will never give your information to a third party without your consent.

Note: Items marked with a * are required.

Employee Information
Pledge Information
*Please apply my gift to:

In honor or memory of:
Engraved Bricks Sample Engraved Brick
Important Note for employees using payroll deduction for an engraved brick3
  • Please make sure your pledge payments reach $150.00 by Jun 30, 2016
  • Utilize the ‘Other:’ field, above, to include your brick inscription
  • Inscription can be three lines; 15 characters per line. Spaces count as one character
  • For brick questions please contact Nathan Fleischmann,
Pledge Amount
Giving Recognition Levels
Pledge Total gift1

Refer to e-mail from Development staff for your current pledge information.

*I would like to pledge $ per pay period.2
  This will generate $0 over a 12-month period.

1 Total gift must be received by June 30, 2016 to be recognized in the 2016 Columbia College Annual Report.
2 Your pledge can be changed or canceled at any time. E-mail for more information.
3 Engraved Brick deductions will cease automatically when the pledge is fulfilled.