Survey - 2023 Employee Giving St. Louis Children's Hospital Payroll Form

Please note: Do not complete this form if you are making your donation and picking up your shirt at the gift shop. There is a form you will fill out there in order to receive your shirt.

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

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 - Department:

Question - Not Required - Other Department:

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Question - Required - Facility where employee works:

Question - Not Required - Other facility:

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Question - Required - How I want 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: ($26 or $1 or more per pay period = t-shirt, $52 or $2 or more per pay period = sweatshirt, $78 or $3 or more per pay period = sweatshirt and t-shirt)

Employees who donate a minimum of $10 per pay period or a one-time donation of $250 to the 2023 Employee Giving campaign by August 1 will be entered to win sets of two all-inclusive Cardinals tickets in the BJC suite. Winners will be contacted one month before the game.

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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)

Question - Not Required - Sweatshirt size: (Unisex sizing. Your one-time donation of $52 or $2 per pay period qualifies you for a sweatshirt. Please note, to receive both spirit t-shirt and sweatshirt you must make a minimum donation of $78 or $3 per pay period. Sizes not guaranteed. Sold out of: S, M, L, XL, 2XL, 3XL)

How will I receive my shirt?

AWS employee shirts will be mailed via USPS.

Between February 6–10:

Visit the Foundation table at various times and locations throughout kickoff week to pick up your Employee Giving apparel. Table times and locations are listed on stlouischildrens.org/employeegiving.

After February 10:

Employees at Children's Specialty Care locations will receive their shirts via campus mail.
If you are making your donation by submitting this form, you will need to pick up your Employee Giving apparel from the Foundation office (1001 Highlands Plaza Dr. West, Suite 160, St. Louis, MO 63110) Monday–Friday from 8:30 a.m.–4:30 p.m.