HSE Schools Payroll Donation Registration

Employee Number (5 digit number found on ID badge)*
Confirm Email*
Select your preferred deduction amount:
  • $1/pay period (not to exceed $24/year)
  • $3/pay period (not to exceed $72/year)
  • $5/pay period (not to exceed $120/year)
I would prefer to donate this custom amount each pay period. (minimum is $1/pay period)
Electronic Signature*
  • I understand that this contribution will continue until I notify Payroll in writing to cancel this tax deductible contribution. This deduction will begin on the next regularly scheduled pay after date of signature.
Date (mm/dd/yyyy)*

Security Code