Instructions for Completing the Pledge Form

A.     EMPLOYEE INFORMATION:  Most employees will receive a form with pre-printed contact information that was used to ensure delivery of their campaign materials.  However, blank forms are also available through the agency volunteer coordinator or on the FSECC website.

Fiscal Agent Code:  This is a 3-digit number specific to the employee’s fiscal agent area and is used by FSECC to ensure that contributions are properly tracked for each area of the state.  The code has been pre-printed on the form and must not be changed.  The agency volunteer coordinator will provide the fiscal agent code to any employee who is using a blank form.

Employee Number:  This is the employee’s current user number in the People First system.  If completing a blank form, locate the number on the top of the employee’s People First home page.

B.     PAYROLL DEDUCTION OPTION:  All employees, including OPS employees, have the option of having their contributions pro-rated by pay period and deducted from their paycheck throughout the next calendar year.  Deductions will automatically stop when the calendar year is over. This option helps employees manage gift giving within their budget.

Minimum Deduction Amount:  In order to keep administrative costs down, the minimum payroll deduction amount per pay period is $2.00 for employees who are paid monthly and $1.00 for employees who are paid bi-weekly.

C.     CASH OR CHECK OPTIONS:  Employees who prefer not to authorize payroll deductions have the option of giving by cash or check.  In these cases, employees must also complete a pledge form, but only Part 1 is required.  All checks should be made out to the “FSECC”.

D.     DESIGNATION(S) REQUIRED:  All employees are required by law to designate their contributions to one or more FSECC participating charity.  The pledge form has space for up to four separate charity designations.  The minimum annual designation is $5.00 per charitable organization to help keep processing costs below the amount the charity was intended to receive.

E.      CHARITY CODE(S):  The FSECC brochure that employees receive with their pledge form has information about each eligible charity and its corresponding charity code. Employee contributions, less the proportionate cost of running the campaign, are sent to the charities that the employees have designated through these codes.

F.      PAYROLL DEDUCTION AUTHORIZATION:  To authorize a recurring payroll deduction, employees must complete Parts 1 and 2 of the form.  Employees MUST write-in the amount per pay period that is to be taken out of his/her paycheck in the blue box in Part 2, as well as the total annual amount in the black box in Part 2.  The form must also be signed at the bottom of Part 2.

Note: Employees must complete a separate pledge form for every payment option they select.

Note:  Make a copy for the employee for his/her records if requested.