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Leadership
Staff
Board of Directors
Where We Work
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Contact Us
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bluemillion
2025-01-04T14:04:52-05:00
Name
(Required)
First
Last
Employee ID
(Required)
School/Dept
Date of Birth
MM slash DD slash YYYY
For payroll deduction identification purposes only
Email
(Required)
Please deduct the amount per paycheck from January 2025 through June 2025 in the Value Per Pay Period field below. You will see the total amount to be deducted within the Total Value from January to June 2025 field below.
Value Per Pay Period
(Required)
This field is hidden when viewing the form
12
Total Value from January to June 2025
(Required)
T-shirt size
SELECT
S
M
L
XL
2XL
3XL
While supplies last, for payroll deduction pledges of $2.50 or more
Signature
(Required)
By signing above you authorize that we can send your info to FCPS Payroll Department for deduction
To donate a one time gift click
here
. To donate a gift of cash or check, please click
here
.
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