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Questions that require an answer are marked with  *
* First Name
* Last Name
* Employee #
* Address
* City
* Zip
* Department
* Campus
* Shift
* Phone Type
* Phone Number
* Email
Recurring Gift
* Levels of Giving
Must be a full-time or part-time employee.

Your gift will be automatically calculated for you.
SELECT ONE: Automatic Payroll Deduction Amount (minimum $5) per pay period
One-Time Payroll Deduction Amount (minimum of $25)
PTO Donation - Semi-Annually (Must have minimum 80hrs in PTO account)
PTO Donation - One-Time (Must have minimum 80hrs in PTO account)
* I want my gift to support:
Unless designated as a recurring gift, all automatic payroll deductions will begin January 2024 and continue for 26 pay periods.

Note: Gifts not designated to a specific project will be put to the Mercy Patient Care Tower general fund.
Person who encouraged or inspired me to join Spirit of Giving:
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