Name *

First Name

Last Name

Phone

(###)

###

####

Donation Amount

Keep my existing payroll amount the same for this year

$25 per pay period through payroll deduction

$15 per pay period through payroll deduction

$10 per pay period through payroll deduction

$5 per pay period through payroll deduction

$1 per pay period through payroll deduction

Increase my current donation by $1 per pay period

Other Amount through payroll deduction per pay period

One Time Donation through payroll deduction

One Time Amount to be paid by Check (Please submit check to Ambassador or mail to 107 Safrit Drive, Beaufort NC 28516)

My Area of Impact

I’d like my donation to be used towards:

Staff PD Fund

Staff Crisis Assistance

Student Crisis Assistance

Area of Most Need

INCENTIVES

Please select all incentives you would LIKE TO receive

I Love Carteret Public School Sticker (Gift of any amount)

T-shirt ($5/month or one time gift of $60 or more)