Icon graphics representing hospitals and giving. Text reads "Giving Together, Working Together"

Employee Giving Form

Employees can use the below form to sign up for payroll deduction gifts (one-time or recurring) or Paid Time Off (PTO) hours. Please note that if you are donating PTO hours, you must have a minimum of 80 hours in your PTO bank.

Other giving options:
- Credit card donation >
- Cash or Check - Send to the Foundation Office

Questions or need help? Please contact Candace Brown at 805-994-5419 or via email.

Questions that require an answer are marked with  *
* First Name
* Last Name
* Employee #
* Address
* City
* Zip
* Department
* Phone Type
* Phone Number
* Email
* 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 $1) per pay period
REQUIRED: One-Time Payroll Deduction Amount (minimum of $10)
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:
Recurring Gift
* Signature (type your name in the box below)
* Today's Date
 Choose a date
* By Checking ‘I Accept’ you are agreeing to all terms and conditions that have been provided.