Survey - 2021 Employee Giving Payroll Deduction - St. Louis Children's Hospital Foundation

Basic Information


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
	Phone Number:
	Yes, I would like to receive communications from St. Louis Children's Hospital Foundation.
	Yes, I would like to receive postal mail from St. Louis Children's Hospital Foundation

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Question - Required - Employee ID# (10 digit # located on the back of your badge):

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Question - Required - Title:

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Question - Required - Floor/Suite:

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Question - Required - Department:

Question - Not Required - Other Department:

*

Question - Required - Department Leader:

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Question - Required - Are you an alternate worksite employee? (AWS employees' t-shirts will be mailed to the address entered above.)

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Question - Required - Facility where employee works:

Question - Not Required - Other facility:

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Question - Required - Mailstop Number (required for campus mail, AWS employees type n/a):

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Question - Required - Ways to Give: (Note: You can contact the Foundation at any time to stop the deduction.)

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Question - Required - Payroll Deduction Gift Amount: (Your one-time donation of at least $26, or $1 or more per pay period, ensures you receive a new spirit t-shirt.)

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Question - Required - Please direct my gift to:

Question - Not Required - Other gift designation:

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Question - Required - T-shirt Size: (unisex sizing)

How will I receive my t-shirt?

All shirts will be sent either via Campus Mail or USPS for AWS employees the fourth week of each month.