Online Contribution Form

Your Information
Name*
First Last
Phone Number*
Address
Street Address Address Line 2 City State ZIP Code
Email Address
Department
Employee ID
Staff Activity/Type
- I am a retired State of Michigan Employee.
Contribution Designation
Is this donation one-time or recurring monthly?*
- One-Time Donation
- Recurring Donation
Please indicate the Umbrella Organization(s) and Member Agency Code(s) to which you would like to donate.
Please indicate the Umbrella Organization and Member Agency Code to which you would like to designate for your monthly recurring donation.
Charity 1*
Donation Amount*
$10 minimum
Monthly Donation Amount*
$5 minimum
Charity 2
Donation Amount
$10 minimum
Charity 3
Donation Amount
$10 minimum
Would you like to give to additional charities?
- Yes
- No
Charity 4
Donation Amount
$10 minimum
Charity 5
Donation Amount
$10 minimum
Charity 6
Donation Amount
$10 minimum
Donation Total
$0.00
Acknowledgement of Contribution
- I wish to have my charitable gift acknowledged by the organization(s) I have designated.
Name
This field is for validation purposes and should be left unchanged.