Employee Giving Program

YES! I want to support University of Utah Hospitals and Clinics.

* = Required field.

Please choose one of the following ways to donate.

I would like to contribute using payroll deduction.

90 minute plan - The equivalent of 90 minutes from each paycheck
60 minute plan - The equivalent of 60 minutes from each paycheck
30 minute plan - The equivalent of 30 minutes from each paycheck
I want to donate by giving: $ from each paycheck for # pay periods.

I want to give a one time donation of: $

Please deduct my gift from my next paycheck.
Cash
Check - Please make checks payable to:
                                                                   University Hospital Foundation
                                                                   540 Arapeen Drive
                                                                   Suite 130
                                                                   Salt Lake City, UT 84108
For credit cards, Please contact Lindsay at 801-585-6963 to make your payment.

Please use my gift to support:

Current Area of Greatest Need.
Other Major Area. Please specify:

I Agree:

If applicable, I authorize payroll to deduct the above amount from my payroll check beginning with the next payroll period.
— OR —
Please start my deduction(s) on the following future date:

All clinical services and programs are part of University of Utah Health