Team Member Giving Form

Please use the form below to initiate or change your donation through Novant Health New Hanover Regional Medical Center (NHNHRMC) payroll deduction.

If you currently have an ongoing payroll deduction and do not wish to make any changes, you do not need to complete the below form as your gift will continue each pay period – even when a new calendar year begins. If you would like to adjust your donation amount or make a change to your fund designation, please complete the form below.

If you wish to end your current deduction, please contact Payroll by following the prompts in Service Now within Human Resources/Payroll Cases.

Are you a current employee at New Hanover Regional Medical Center?

YesNo

Please refer to the iConnect Gratitude Campaign page here.

Contact Information

Last Name:

First Name:

Employee Email Address:

Phone:

Department:

Employee ID Number (not your badge number):

Donation Information

Do you have an active Foundation payroll deduction?

YesNo

What change/s are you looking to make?

Fund DesignationAmountBoth

I wish to payroll deduct the following amount each pay period:

I wish to designate my deduction to the following at Novant Health NHRMC:

Other amount I wish to payroll deduct each pay period:

Share why you are giving:

For questions related to team member giving in the New Hanover market, please contact NHRMC Foundation at (910) 667-5002. If you wish to end your current deduction, please follow the prompts in Service Now within Human Resources/Payroll Cases.