Establishing Payroll Deduction

Your gift as a member of the Vanderbilt University Medical Center family is especially meaningful. When each of us gives back–at any level–we help the medical center move forward in its mission.

Please read the following steps before completing this form.

(Please note: payroll deductions can take up to 2 weeks to be set up.) If you have questions about payroll deduction, please call the Partners In Health office at (615) 343-7531.

Step 1: Choose the type of gift you would like to make:
One-time gift via payroll deduction

The amount of this gift will be deducted from your paycheck within the next two months.

Amount of gift: $

Please deduct this amount from my salary for the month of .

Annual gifts of $1,000+ qualify you for membership in a donor society. Learn more about the medical center donor societies.

Open-ended gift via payroll deduction

The amount of this gift will be deducted from your paycheck on a monthly basis.

(This deduction will continue to occur until you notify the Gift Processing Office at advance.giftupdate@vanderbilt.edu.)

Amount of monthly gift: $

Please begin deducting this gift from my salary each month beginning in .

Is this a change to your current payroll deduction?

Annual gifts of $1,000+ qualify you for membership in a donor society. To join a donor society, make a one-time annual gift of $1,000 or a monthly gift of $83.34 for 12 months. Learn more about the medical center donor societies.

Specified pledge amount for a defined time period via payroll deduction

You will determine the amount of your total gift and the number of months that you would like this gift to be deducted from your paycheck.

(Payroll deduction gifts are deducted on a monthly basis. If you would like to make a gift of $1,000 and pay it off over 12 months, then you would choose this option. You would also choose this giving option if you would like to make a multi-year pledge via payroll deduction (e.g. $10,000 gift payable over five years via payroll deduction.)

Total amount of gift: $

Number of months to pay off pledge gift:

$ will be deducted from your paycheck each month.

Please begin deducting this gift from my salary beginning in .

Annual gifts of $1,000+ qualify you for membership in a donor society. To join a donor society, make a one-time annual gift of $1,000 or a monthly gift of $83.34 for 12 months. Learn more about the medical center donor societies.

One-time gift via credit card

Click here if you would like to make your gift via credit-card.

Step 2: Area(s) you would like to support:

There are many areas and funds within the Vanderbilt University Medical Center, so not all can be listed below. Please list the area(s) in which you have interest. (All gifts will be distributed equally unless a percentage is specified.)

      Specific Area? %
  School of Medicine
  School of Nursing
  Monroe Carell Jr. Children's Hospital at Vanderbilt
  Vanderbilt-Ingram Cancer Center
  Vanderbilt Kennedy Center for Research on Human Development
  Vanderbilt University Medical Center
  Other area(s) you would like to support %
   
   
   
  The Gift Processing Office will contact you to clarify your interest and the fund if there are questions. Total percentage:


Make this gift in honor/memory of someone »

This gift is     in honor of        in memory of

First Name:        Last Name:

Special Comments: (limited to 200 characters, including spaces)

Step 3: Your contact information:
Salutation
First Name:
Middle Name:
Last Name:
Jr./Sr./etc.:
Employee ID#: What is this?
Vanderbilt Department:
Title:
Address Line 1:
Address Line 2:
City:
State:
ZIP:
Country:
Work Phone:
Home Phone:
E-mail Address:
An e-mail confirmation will be sent to this address when your gift has been processed.

Please check here if you do not wish this e-mail address to be included in your Vanderbilt record.
Add spouse/partner Information (if a joint gift)
First Name:

Middle Name:
Last Name:
If spouse/partner is a Vanderbilt employee:
Employee ID#: What is this?
Vanderbilt Department:
Title:

 

If you are having trouble with this form, please contact us at (615) 343-7531 between the hours of 8 a.m. and 5 p.m. Central time, Monday-Friday, or by e-mailing us at partnersinhealth@vanderbilt.edu. We will respond to any e-mail inquiries by the end of the next business day.

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