Central Carolina Community College (CCCC)

• First Name*
• Last Name*
• Email Address*
• Phone Number
• The amount to be deducted from my monthly salary*
• Total number of months to process the deduction (period beginning July 1, 2021 through June 2022)*
• The total amount of my pledge is*
• Please select how the gift should be used*

  I would like my gift to be added to the General College Support Fund for student, faculty and staff needs as provided through the Foundation Awards Program.I would like my gift to be added to a specific fund.
• If specific fund, please indicate which fund

By completing, selecting "I Agree", and electronically signing this form, I hereby certify that the information provided in this application is accurate and complete to the best of my knowledge. I agree to have this money deducted from my monthly salary in the terms listed above.

• Electronic Agreement*

  I agree
• Full Name*
• Submit