2022 Online Pledge Form

PLEASE TAKE NOTICE

Pledges for Campaign Year 2022 have concluded. All new submissions will be applied to campaign year 2023. For payroll pledge submissions this means payroll deductions for your gift will not begin until January 2023

SECC Online Pledge Form

Thank you for participating in this year's State Employee Combined Campaign. With your support and donations, we are all MAKING A DIFFERENCE TOGETHER!!

Would you like to keep your gift anonymous to charities?

Check YES if you DO NOT want any designated charities to receive your name or address from the SECC when sending donation information

Yes, Keep my gift anonymous to my designated charities

Name(Required)

First Last

Department/University(Required)

Enter the General Govt Department or University that you work in

Division/Academic Unit(Required)

Please enter the sub division, sub department, etc. that you work in

Home Address

***ONLY PROVIDE THIS INFORMATION IF YOU WISH TO RECEIVE A GIFT ACKNOWLEDGMENT BY MAIL***

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Daytime Phone

Email(Required)

Enter Email Confirm Email

Pledge and Payment Options

Please Choose a Payment Option for your Pledge(Required)

Note - By Choosing "Payroll" below, you are authorizing payroll deduction to pay your pledge throughout 2023. Please review your January 2023 pay stub to confirm that your SECC donation was deducted.

Payroll Deduction ($3 minimum per month)

Check (MAKE PAYABLE TO NC SECC & mail with printed confirmation email or form to PO Box 196 Durham NC 27702

Cash (Mail with printed confirmation email to PO Box 196 Durham NC 27702)

Credit Card

Stock Transfer/Matching Gift (Contact SECC office to provide details)

Payroll Amount to Deduct EACH Pay Period

Please enter the amount (numbers only) to be deducted from your paycheck EACH pay period. ($3 minimum is required per month)

Total Pledge(Required)

Enter the TOTAL amount you wish to pledge. (FOR PAYROLL PLEDGES - this is the TOTAL YEARLY DONATION)

Employee ID

Enter your Payroll Deduction/ BEACON #, if applicable

Gift Designations

Approved Charities are listed in the 2022 SECC Giving Guide and can also be found using the charity search at ncsecc.org. Pledge money left undesignated or designated to a charity not listed will be deemed undesignated funds. Undesignated funds are proportionally distributed to charities receiving designated gifts. A minimum of $10 per year and per charity is required to designate.

Charity Designation Choices

Please use the table below to enter the information for all charities you wish to designate part of your donation to (**To add additional designations, click the + on the far right of the top row of designations**). Please be sure to include information for all fields. (IF KEEPING YOUR GIFT UNDESIGNATED, PLEASE LEAVE ALL FIELDS BLANK)

SECC Code

Charity Name

Yearly $Amount to Designate

Disclosure

Your SECC contribution is tax-deductible to the extent allowed by law. For tax purposes, nothing of substantial value was given in return for this contribution. Retain a copy of your pledge form and either your canceled check, credit card statement, or year-end payroll deposit slip as proof of your contribution. Call the NC SECC office at 919-821-2886 for more information, if needed. THE FEDERAL TAX ID (EIN) FOR THE NC SECC IS 56-1775025

Total

Credit Card Pledge Payment*

American Express

MasterCard

Visa

Card Number Expiration Date mm/yy Security Code Cardholder Name

**PLEASE TAKE NOTICE**