Set up a Combined Charitable Campaign (CCC) Deduction

You may support either or both of the two funds noted below for the 2022 CCC campaign.

If you wish to support our students through a different foundation fund, please do so at www.supportmadisoncollege.org/payroll-deduction-form/

Name*
First Last
Employee ID*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Deduction will begin in January 2023 and end in December 2023.
Gift Designation (Check one or more boxes below)*
- Smart Future Scholarship (A general scholarship fund to support students from all program areas)
- George Floyd Memorial Scholarship (A fund to support African American students)
Enter Amount Per Pay Period (this amount will be deducted from every payroll in 2023)*
Notes

If multiple designations were selected, please use the notes section above to indicate amount per fund.
Please Check to Confirm*
- I authorize Madison College Foundation to set up this payment on my behalf.
Signature (type your full name)*

Deduction will begin in January 2023 and end in December 2023.