Fields marked * require an entry.

Every day you see firsthand how Santa Rosa Junior College is changing lives. Throughout the year, you dedicate your talent, knowledge and heart to SRJC and its students.

Take an extra step as part of SRJC’s faculty and staff to make a personal financial gift to ensure that SRJC stands for opportunity for our students. Your support helps provide the scholarships, enhanced student opportunities, specialized learning equipment, instructional excellence and academic programming that have earned SRJC its first-rate reputation.

The Voluntary Payroll Deduction Program helps you to make a significant gift to SRJC by dividing your contribution into smaller portions paid throughout the year. Each month your donation will be deducted automatically from your paycheck. Voluntary Payroll Deduction is an affordable way to make a difference for an area you wish to support.

Questions about which fund to select? Contact Sarah Laggos at slaggos@santarosa.edu or 707-527-4733.

Voluntary Payroll Deduction Form

Yes! I wish to support SRJC through a monthly payroll deduction!

Gift Information:*

New monthly deduction
Add/Increase my current deductions
One-time deduction
Change my current deductions

Payroll Schedule:*

10 month
12 month

Designate Your Gift

If you wish to designate your gift to a particular fund (i.e. a named scholarship, program or department), please specify below. If you wish to give to the area of greatest need, please select that option.:

Program
Scholarship
Department
Unrestricted/Area of Greatest Need

Name of specific program, scholarship or department fund (if applicable):

Donation Amount:*

Effective Date (Today's Date):*

Permission to publicize name in donor recognition materials:*

YesNo

Your SRJC employee ID number (found on paystub or in employee portal):*

I authorize the Payroll Office to deduct this amount from my wages. :*

YesNo

Department/Office:

Employee Classification:

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country:*

Mobile Phone:

Home Phone:

Email:*