Florida State College

Watch Your Investment Grow - FCCJ Foundation Annual Campaign 2007

Faculty and Staff Drive Pledge Form

*Denotes required information.

Personal Information:
Title:
First Name:*
Middle Name:
Last Name:*
Maiden Name:
Street:*
City:*
State:*
Zip Code:*
Home Phone:	ex. 904-633-0989
Campus Information:
Position:*	ex. Admin. Asst. I
Birthday:*	ex. October 22
Campus:*	ex. Kent Campus
Building/Room:*	ex. A-203
Telephone:*	ex. 904-632-0000
E-mail:*	ex. john@fscj.edu
Pay by Check:
To pay by check, download the pledge form (PDF), print and complete it, and return it with your check (made payable to the Florida State College Foundation, Inc.) through interoffice mail to the Florida State College Foundation, Inc., Martin Center, Room 104D. Note: PDF files require Adobe Reader software. Download the free Adobe Reader from Adobe’s Web site.
Payroll Deduction:
(Effective immediately, deduct $ per pay period (minimum $1 per pay period).
Choose one of the following options to select the number of deductions taken:
1. 9-month contract (18 deductions)
2. 12-month contract (24 deductions)
3. 48-month contract - I agree to make a four-year pledge to the campaign.
Programs:
*Please Read: If you are giving to more than one Florida State College at Jacksonville area, please be sure the combined total amounts to the pay period deduction you entered above. Please use round dollar figures. If the program that you wish to donate to is not listed in Section 1, please use Section 2 to designate your pledge by typing in the appropriate account name. There are multiple boxes in case you wish to give to several areas, but only one needs to be completed.
Section 1: Florida Community College Greatest Needs
Program:
Amount:	$ (per pay period)
Program:
Amount:	$ (per pay period)
Section 2: Foundation Account Name — Select From Fund Designation List
Account Name:
Amount:	$ (per pay period)
Account Name:
Amount:	$ (per pay period)
Account Name:
Amount:	$ (per pay period)

Thank you for your support! If you have questions, please contact Herschel Finch at 904.632.3173.

Are you ready to submit your completed form?

Want a Printed Pledge Card? Download the pledge form now (PDF), print and complete it, and return it through interoffice mail to the Florida State College Foundation, Inc., Martin Center, Room 104D.

Note: PDF files require Adobe Reader software. Download the free Adobe Reader from Adobe’s Web site.