Saint Mary’s Hospital Foundation, Inc., Trinity Health

Colleague Giving Donation Form

The Saint Mary's Hospital Foundation is proud to provide support to our Hospital and our community and we're inspired by the impact that we can have – together. Thank you for your support of Saint Mary's Hospital, and your consideration of a gift to this year’s Campaign.

Step 1: Colleague Information

Name *
Address *
 Address 2
City *
State *
 Zip *
Phone *
 Email *
Colleague ID # *
 Department

Step 2: Designation
Name
 Department

Step 3: Contribution (Please select one)

1. Payroll Deduction

I authorize my PAYROLL DEDUCTION of $ per Pay Check (every two weeks).
I wish to change my current PAYROLL DEDUCTION as of to $ per Pay Check (every two weeks).
I authorize a onetime PAYROLL DEDUCTION of $.

2. Check Donation

Check Donation of ($)

Make checks payable to Saint Mary's Hospital Foundation.
A member of the Saint Mary�s Foundation team will contact you with details on where to submit your gift.

3. Cash Donation

Cash Donation of ($)

A member of the Saint Mary's Foundation team will contact you with details on where to submit your gift.

Step 4: Appreciation Gift

Gifts of $100 or more receive a "be inspired" long-sleeve t-shirt (while supplies last):

 
T-Shirt Size