NSCC Employee Donation Form 1 Donor Information2 Donation Name Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Middle Last Suffix A NumberDepartmentOffice NumberHome Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email PhonePhone Number TypeWorkCellHomeSignatureDate Date Format: MM slash DD slash YYYY Gift Information Recurring Gift$100 per month$50 per month$30 per month$20 per monthOtherRecurring gifts will be deducted each payroll period at this amount until the donor specifies that the gift amount be amended or the gift canceled.Other Amount Per MonthEnter the amount you would like to donate each month.One Time Gift$1000$500$250$100$50$25OtherRecurring gifts will be deducted each payroll period at this amount until the donor specifies that the gift amount be amended or the gift canceled.Other One Time GiftEnter the amount for your one time gift. Designation I would like this gift to remain anonymous. I would like to help the Foundation support students’ greatest needs through the Impact Fund. I would like my gift(s) to support the following scholarship or other initiative: Please note that all undesignated gifts will default to the Foundation’s Impact Fund which supports NSCC students’ greatest needs.Tell us the scholarship or other initiatives you would like to support.Legacy I would like to leave a legacy and have included NSCCF in my will or trust. I am interested in leaving a legacy and would like more information about how to include NSCCF in my will or trust.