Payroll Deduction
Questions that require an answer are marked with  *
1 * First Name
2 * Last Name
3 * Preferred Title (Mr., Dr., Mrs., Ms., etc)
4 * Sparrow Associate ID Number
5 * Home Street Address
6 * Home City
7 * Home Zip Code
8 * Telephone numbers, in order of preference, where you may be reached in case of questions. Please add phone type before number (i.e. cell 555-555-5555).
9 Telephone #2
10 * Preferred email address (Sparrow email address will be used for confirmation)
11 * Which area(s) do you wish to assist? (Unless otherwise requested, your gift will be split equally between your choices.)
Click here for a complete list of funding options

12 * How often and how long would you like to give?
13 If you chose 12a, 12b, 12c or 12d above, how much would you like each payroll deduction to be?
14 If you chose 12c, 12d, or 12e above, what is the total dollar value of your desired gift?
15 * This payroll deduction....
16 If you would like your spouse included in your acknowledgement letter, please enter your spouse's name and how we should address your spouse. (example: Mr. John Doe, Mrs. Jane Doe etc.)
17 Additional Comments
18 * I agree to payroll deduction for the gift described above. Sparrow Foundation will verify all submissions with current Human Resources data before beginning payroll deduction.

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