Donations – Region One ESC E-Pledge Card Region One ESC Employee Pledge Form Name/Nombre* First Middle Last Campus/Dept./Departamento* Complete Employee ID #/Número Completo de Empleado* Last four of your SS#/Últimos 4 números del Seguro Social Donation Amount Per Pay Period/Cantidad de Donacion por Periodo de Pago.*Pay Period Frequency/Frecuencia de Periodo de Pago* Monthly/Mensual Semi-Monthly/Semi-Mensual Email/Correo Electrónico* Address/Residencia Street Address Address Line 2 City State / Province / Region ZIP / Postal Code I authorize Region One ESC Payroll Department to process the pledge information entered above for payroll deduction beginning January 2022 through August 2022.* Agree Δ
