Employee Campaign

Make a Gift – Payroll Deduction

By submitting this form, you are authorizing Connecticut Children’s Medical Center to deduct the selected amount from your paycheck as a one-time gift or an ongoing gift with no end date. Please note: Payroll deductions will occur the in the next pay period following submission of your gift. If you have any questions or need assistance completing this form, please contact the Foundation at (860) 837-5700.

  • Your Employee ID can be located at the top of your pay statement, which can be found by logging into the ServiceNow¬†self-service portal.
  • You will receive a pledge confirmation email, to the address provided, immediately following form submission.

Payroll Deduction Commitment Form