Employee Giving 

Name

Department

Employee ID Number

Date

Home Address

City/State/Zip

Email Address

Phone Number

Please recognize me/us as:

Would you like to remain anonymous? Would you like to remain anonymous? Yes

One time donation? (leave blank if giving monthly) One time donation? (leave blank if giving monthly) $1 $2 $5 $10 $15 $20 $50 $100

Other?

I would like to give from each paycheck: (leave blank if only giving once) I would like to give from each paycheck: (leave blank if only giving once) $1 $2 $5 $10 $15 $20 $50 $100

Other?

Please apply my contribution to: Please apply my contribution to: YDI General Fund Employee Scholarships Emergency Assistance for Families

Authorization Authorization I authorize Youth Development, Inc. to deduct the amounts selected.

Name

Is there anything you would like us to know?