2025 Employee & Volunteer Gifts Campaign

April 14 - May 16

Payroll Deduction Pledge - 2025 EVGC

2025 Employee and Volunteer Gifts Campaign

Name(Required)

First Last

Email(Required)

Department(Required)

Date(Required)

Employee ID(Required)

Payroll Deduction Pledge

Payroll Deduction: Please enter the amount of money you'd like deducted from the number of pay periods for a total donation amount.

Dollar Amount

Number of Pay Periods

Total Donation Amount

Example - Deduct $5 from my paycheck over the next 26 pay periods for a total donation of $130. Deductions will begin early October 2025.

I want this to be a recurring gift as my commitment to providing ongoing support(Required)

Yes

Changes to or questions about recurring gifts can be directed to Ben Craig at bxcraig1@sentara.com

Areas My Gift Will Support

Choose where to designate your gift:(Required)

Employee Relief Fund: Helping our own team members in a time of need. Sentara will match your gift dollar-for-dollar to this fund.

RMH Priority Fund: Wherever the need is greatest at the hospital.

To benefit the following SRMH department (signify immediately below).

Designate my gift to a specific department or program:

Campaign Ambassador Referral

Was there an SRMH employee who encouraged your gift to this year's campaign? List their name below.

Ambassador Name

Double My Impact

I would like my gift to this year's campaign (2025) matched by Sentara's Fidelity Matching Gift Program(Required)

Yes - full amount: Please have the full amount of my gift matched by Sentara.

Yes - partial amount: I am interested in having a portion of my gift matched by Sentara.

No: I would prefer my match be saved for other charities that I support.

Financial gifts you make to the RMH Foundation are eligible for a matching gift through Sentara’s Corporate Match Program powered by Fidelity. Sentara will match your donation to the RMH Foundation (and other qualifying non-profit charities) up to $1,500 annually. Typically, you - as the donor - have to log into Sentara’s Charitable Matching Gift Program powered by Fidelity Marketplace to request the match. However, the RMH Foundation has been afforded the option by Fidelity Marketplace to automatically assign your gift match to us... requiring no further action by you. Your matching gift will be directed to the same fund designation(s) as your original gift made to this year's Employee & Volunteer Gifts Campaign.

What portion of your gift ($ amount) would you like to have matched by Sentara