2023-24 Pay It Forward Campaign

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

PAYROLL DEDUCTION FORM

The KSD Education Foundation is excited to continue to support our staff while they continue to enrich educational experiences in our incredible district this year! Last year, we provided an additional $1,000 scholarship with the $1,300 donated. Thank you for partnering with us!

Email *

DONOR DETAILS

Employee Name *

Building Name *

Home Address *

Home City *

Home State *

Home Zip Code *

Preferred Phone Number *

DONATION DETAILS

I would like to support the KSD Education Foundation with a payroll deduction gift of:
*

$20 per month

$10 per month

$7.50 per month

$5.00 per month

Other:

How would you like to be listed on our annual Staff Donor Recognition webpage? (Mr. and Mrs. John Doe, Ms. Jane Doe, John and Jane Doe, etc.)
*

Receive a donor exclusive t-shirt with a minimum $10/month payroll deduction. This super soft shirt is Bella+Canvas brand, unisex sizing. The shade is Purple Heather. Please select your t-shirt size (if applicable).

X-Small

Small

Medium

Large

X-Large

Clear selection

PAYROLL DEDUCTION AUTHORIZATION

I hereby authorize Kearney Public Schools to deduct the indicated amount from payroll. The school district is authorized by me to remit the KSD Education Foundation the amount deducted through the end of the 23-24 school year. My authorization will continue unless canceled or revised by me in writing or upon termination of my employment. Please type your name for authorization:

Type your name for authorization.

Thank you for supporting your Foundation and "Paying It Forward!"

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Kearney School District. Report Abuse

Forms