Survey - OLG Employee Giving Form - Ochsner Clinic Foundation

Choose the area that you would like to support from the drop down below. Thank you for your thoughtful generosity!

Gift Designation

Choose an area to support:

Question - Not Required - Designee Text Field

(Maximum response 255 chars, approx. 5 rows of text)

Type of Gift

*

Question - Required - Please choose one of the following:

Make this a payroll deduction (bi-weekly)

Donate the cash value of GPT/Vacation hours (enter the number of hours below)

*Your payroll deduction will automatically continue every year, and you will not need to take any further action unless you choose to opt-out by contacting the Physician and Employee Giving team at employeegiving@ochsner.org.

*Rush Legacy hours cannot be donated.

Please click here to make a direct one-time gift.

Gift Amount

*

Question - Required - Amount: (Enter the number of hours or the bi-weekly payroll deduction amount)

For payroll deduction, enter the bi-weekly payroll deduction amount and not the total yearly amount.

Gift Options:

Question - Not Required - Would you like to remain anonymous from public recognition?

Personal Information

Please fill out your personal information below (required):

*

Name:

First Required	Last Required

*

Email: Required

*

Street 1: Required

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Country: Required

Phone Number:

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OLG Employee Giving Form

Gift Designation

Type of Gift

Gift Amount

Gift Options:

Personal Information

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