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 (Please note: Campaign deductions will begin the next pay period and will have no end date.

  • Please enter the total amount you would like to contribute over 52 weeks if choosing your own donation amount. Minimum donation must be at least $26 ($1/bi-weekly or $2.16/month) to qualify for payroll deduction.
  • 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.

If you have any questions or need assistance in completing this form, please contact the Foundation at (860) 837-5700.

Payroll Deduction Commitment Form