Make a Gift - Employee Payroll Deduction - St. Johnsbury Academy

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SJA Employee Payroll Deduction Form

If you prefer to pay by check, please drop off your gift to the team at the Straszko Center or leave in Tammi Cady’s box in the mail room in Colby.

Credit card gifts can be made here.

Questions? Contact Brynn Reynolds Evans ’98 at x2129 or brynn.evans@stjacademy.org.

Download Payroll Deduction Form

Employee Name
Prefix
First Name*
Last Name*
SJA Email*
Suffix
Payroll Deduction Gift Details
I wish to support St. Johnsbury Academy by contributing through payroll deduction. I would like my gift to be credited to:*
- The Center for Student Life and Athletics
- The Annual Fund (SJA Fund)
- Endowment
- Other
If Other, allocate my donation to:
My gift will be paid via payroll deduction through one of the following methods:*
- One-Time Lump Sum Gift
- Payroll Deduction Based on a Specific Pledge Amount
- Payroll Deduction Based on Start and End Dates
- Payroll Deduction with No End Date
I authorize St. Johnsbury Academy to deduct this amount in a one-time lump sum gift from my paycheck. Please enter $ amount here.*
The amount should be taken out on this date:*
MM slash DD slash YYYY
I authorize St. Johnsbury Academy to deduct this amount per pay period. Please enter $ amount here.*
This should be deducted until my total gift equals this amount. Please enter total pledge $ amount here.*
Deductions will begin on:*
MM slash DD slash YYYY
I authorize St. Johnsbury Academy to deduct this amount per pay period. Please enter $ amount here.*
My total pledge will equal this amount. Please enter $ amount here.*
Deductions should begin on this date*
MM slash DD slash YYYY
Deductions should end on this date
MM slash DD slash YYYY
I authorize St. Johnsbury Academy to deduct this amount per pay period until such time as I end my employment or notify the Payroll and Development Offices of a change or termination of the gift noted. Please enter $ amount here.*
I would like to recognize someone special
- Yes
- No
Dedication Type
- in honor of
- in memory of
Honoree First and Last Name
Note about your gift:
CAPTCHA
By signing here, I give my permission to have my donation(s) to St. Johnsbury Academy be made via payroll deduction. I also understand that my payroll deductions will end when my employment at St. Johnsbury Academy ends.
Signature*
Today's Date
MM slash DD slash YYYY

Δ

An independent, coeducational, boarding and day school for grades 9-12 and postgraduate year.

1000 Main Street

St. Johnsbury, Vermont 05819

(802) 748-8171

hilltoppers@stjacademy.org

49 Perkins Street

St. Johnsbury, Vermont 05819

(802) 751-2305

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