Please use the form below to initiate or change your donation via payroll deduction to one of the following Novant Health community partners:

American Heart Association
American Red Cross
March of Dimes

If you currently have an ongoing payroll deduction supporting one of the organizations listed above 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 selection change, please complete the form below.

Deductions to a community partner do not overwrite or replace active payroll deductions to Novant Health Foundation.

Please Note: Payroll deductions supporting Novant Health community partners are only applicable to North Carolina team members. South Carolina team members are unable to enroll in payroll deductions supporting community partners at this time.

Contact Information

Last Name:

First Name:

Employee Email Address:

Mobile Phone:

Employee ID Number:

Department:

Home Address

Street Address:

City:

State:

ZIP Code:

Donation Information

Do you have an active payroll deduction supporting one of the community partners listed above?

YesNo

What change are you looking to make?

I wish to update my current allocations.I would like to end my active payroll deduction.

Please complete the following steps to initiate your payroll deduction.

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

Other amount I wish to payroll deduct each pay period:

I wish to designate my deduction to the following organization:

How did you learn about Giving.Serving.Together.?

Other way you learned about Giving.Serving.Together.

Share why you are giving:

Please note the sum of all deductions provided above equals the total deducted per pay period and will be an ongoing donation each paycheck. Team members may choose to select all three (3) organizations.