Join Our Team
Join Our Team
Employee Giving Pledge Form
Solicitor (Giving Ambassador)
Step 1: Choose the program(s) you want to support
You can pick many programs as you wish to support
Area of greatest need - Employee Giving Committee will decide where the dollars are needed the most.
Immediate Needs Fund - Assists patients/participants who do not have access to basic necessities that affect their health and well-being.
Employee proposals - Sites/departments will be able to submit a brief proposal for consideration to support the patients, participants, and communities we serve.
Step 2: Tell us how much and how many installments
Your donation amount will be split evenly amongst all the programs you select to support.
A. Ongoing deduction (Recurring pay periods)
Recurring Donation per pay period
Recurring Pay Periods
B. 1-year commitment
Donation per pay period x 26 pay periods
26 Pay Periods
C. One-time deduction
Donation per pay period x 1 pay period
1 Pay Period
TOTAL DONATION AMOUNT
If you selected option A, recurring payments, the total amount is the dollar amount
per pay period that will be deducted
and does not reflect the total donation you will make.
I acknowledge that I am instructing AltaMed Health Services Corporation to make automatic payroll deductions for my participation in the employee giving program. I understand I can modify or cancel my participation at any time in the future.
I understand that my authorized deduction will stay in place for the length of time I have designated above unless I inform the Development department in writing of my decision to modify or cancel the deductions. There are no reimbursements once a deduction has been made.
I understand that my participation in the employee giving program is completely voluntary and that I will not receive compensation or benefits for my participation.
Please enter your full name below to confirm your participation in the program:
I am a description. Click the edit button to change this text.
Thank you for your pledge!
Your contributions are tax deductible to the extent permitted by law. Tax ID # 95-2810095
There are no reimbursements once a deduction has been taken.
Note: Payroll deductions will always start with the beginning of a new pay period.
For all program inquiries, changes to pledge amounts or cancellation of pledge please email the Development Department at
If you have any questions, feel free to contact our Development Department by email at
or call us at (714) 495-0388.
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