Centerstone Employee Giving – Evergreen Switch to Credit Card Switch to Evergreen Switch to Payroll Deduction "*" indicates required fields Step 1 of 2 50% NAME (as listed with HR):* First Name Last Name EMAIL FOR CONFIRMATION:* CENTERSTONE STAFF ID (Available in Workday):*HOW I WOULD LIKE TO BE RECOGNIZED (if different than NAME above, i.e. Robert vs Bob):ADDITIONAL OPTIONS: I prefer my gift be recognized as "Anonymous" I AM BASED/LOCATED IN THIS STATE:* Florida Illinois Indiana Tennessee Other My Base/Location State I WISH TO...* Increase my Evergreen donation Begin a new Evergreen donation Decrease my Evergreen donation Discontinue my Evergreen donation Choose the amount you wish to donate each paycheck and we will calculate your annual gift total. $2 per paycheck ($52 per year) $5 per paycheck ($130 per year) $10 per paycheck ($260 per year) $15 per paycheck ($390 per year) $20 per paycheck ($520 per year) $25 per paycheck ($650 per year) $50 per paycheck ($1300 per year) $75 per paycheck ($1950 per year) $100 per paycheck ($2600 per year) Other per paycheck One Time Donation - deducted first paycheck in January Choose the ADDITIONAL amount you would like to add to your current Evergreen deduction. $2 per paycheck ($52 per year) $5 per paycheck ($130 per year) $10 per paycheck ($260 per year) $15 per paycheck ($390 per year) $20 per paycheck ($520 per year) $25 per paycheck ($650 per year) $50 per paycheck ($1300 per year) $75 per paycheck ($1950 per year) $100 per paycheck ($2600 per year) Other per paycheck One Time Donation - deducted first paycheck in January Choose the amount you wish decrease each paycheck and we will calculate your annual gift total. $2 per paycheck ($52 per year) $5 per paycheck ($130 per year) $10 per paycheck ($260 per year) $15 per paycheck ($390 per year) $20 per paycheck ($520 per year) $25 per paycheck ($650 per year) $50 per paycheck ($1300 per year) $75 per paycheck ($1950 per year) $100 per paycheck ($2600 per year) Other per paycheck One Time Donation - deducted first paycheck in January Other Amount Per PaycheckOther Amount One Time AnnuallyWHERE I WOULD LIKE MY DONATION TO BE USED (click and choose one):*Brighter Future FundCARES Fund (direct client assistance)Changing Lives Together Fund (Area of Greatest Need)Endowment (securing Centerstone's future through philanthropy)Military ServicesResearch Institute/National Mental Health Research FundTo help us serve our staff better, your feedback about why you are discontinuing your gift would be helpfulChanging Lives Together Fund (Area of Greatest Need) Anywhere at Centerstone Florida Illinois Indiana Military Services Tennessee CARES Fund (direct client assistance) Anywhere at Centerstone Florida Illinois Indiana Tennessee Military Services National Veterans Counseling Fund Cohen Military Family Clinics - Clarksville, TN Cohen Military Family Clinics - Fayetteville, NC Cohen Military Family Clinics - Jacksonville, FL Capital Campaign Capital Campaign - Unrestricted Capital Campaign - Military Services - National Veterans Counseling Fund Capital Campaign - Military Services - Cohen Clinics - Unrestricted Capital Campaign - Military Services - Cohen Clinic - Clarksville Capital Campaign - Military Services - Cohen Clinic - Fayetteville Capital Campaign - Military Services - Cohen Clinic - Jacksonville Capital Campaign - Institute - Simulation Training Center Other restriction (state/program)Endowment The A John Rose Endowment Fund The Barry S. Hale Endowment Fund The Bonnie Brackett Endowment Fund The Brad Smith Endowment Fund The Carol Zwick Endowment Fund The Chris Julian Fralish Endowment Fund The Colleen Thayer Endowment Fund The Dana Oman Endowment Fund The David J. Emmert Endowment Fund The David Melby, PhD, Endowment Fund The Deborah Taylor Tate Endowment Fund The Dede Wallace Fund (supports services in TN - Davidson and contiguous counties) - *R The Doug Leonard Endowment Fund The Dr. Raghu Upender Endowment Fund The Dr. Stephen J. Pritchard Endowment Fund The Duke Legacy Endowment Fund (supports care in Florida) The Ella P. Hayes Fund (supports services in TN) - *R The Geoff McKim Endowment Fund The George Bullard Stadler Endowment Fund The George Spain Research Fund (supports behavioral health research) - *R The Jack Wallace Endowment Fund The James E. Sweeten Endowment Fund The Janet Ayers Endowment Fund The Jennifer Embree Endowment Fund The Jennifer L. Bencie, MD Endowment Fund The Joan C. Sivley Endowment Fund The Jonathan Morphett Endowment Fund The Joseph E. Roche Endowment Fund The Josie Seybold Endowment Fund The Kelly Crockett Endowment Fund The Lee Ann Summers Ingram Endowment Fund The Lee Brackett Endowment Fund The Lieutenant General (Retired) Hubert G. Smith Endowment Fund The Linda Trader Endowment Fund The Lisa Hooker Campbell Endowment Fund The Mark Faulkner Endowment Fund The Michael J. McCalip Endowment Fund The Mike Enos Endowment Fund The Philip D. Krebs Endowment Fund The Philippa M. Guthrie Endowment Fund The R. Parker Griffith Endowment Fund The Reed Farley Endowment Fund The Reverend Bob Phillips Endowment Fund The Reverend James T. Golden Endowment Fund The Richard D. Sivley Fund (A) (supports children and youth services in TN - Davidson and contiguous counties) - *R The Richard D. Sivley Fund (B) (supports children and youth services in TN) - *R The Richard H. Fitzgerald Endowment Fund The Sally Sheahan Endowment Fund The Steven C. Holman Endowment Fund The Steven E. Bryant Endowment Fund The Terrye Davidson Endowment Fund The Thomas W. (Tom) Mahler, Jr. Endowment Fund The Timothy A. Knowles Endowment Fund The Tom Johnson Endowment Fund PhoneThis field is for validation purposes and should be left unchanged.
