Centerstone Employee Giving Campaign

NAME (as listed with HR):*

First Name Last Name

CENTERSTONE STAFF ID (Available in Workday):*

I WISH TO...*

Choose the amount you wish to donate each paycheck and we will calculate your annual gift total.

Choose the ADDITIONAL amount you would like to add to your current Evergreen deduction.

Choose the amount you wish decrease each paycheck and we will calculate your annual gift total.

Other Amount Per Paycheck

Other Amount One Time Annually

WHERE I WOULD LIKE MY DONATION TO BE USED (click and choose one):*

To help us serve our staff better, your feedback about why you are discontinuing your gift would be helpful

Changing Lives Together Fund (Area of Greatest Need)

CARES Fund (direct client assistance)

Military Services

Other restriction (state/program)

Endowment

ADDITIONAL OPTIONS:

EMAIL FOR CONFIRMATION:*

I AM BASED/LOCATED IN THIS STATE:*

My Base/Location State

Email

This field is for validation purposes and should be left unchanged.