West Jefferson Hospital Foundation Employee Giving Pledge Form 2026

1. Click ‘Get Form’ to open the West Jefferson Hospital Foundation Employee Giving Pledge Form in our editor.
2. Begin by filling out your employment details. Select whether you are employed with O WJMC, O NOPS, or O LCMC. Then, enter your name and the last four digits of your Social Security number.
3. Complete the contact information section by providing your department, home address, city, state, home phone, cell phone, zip code, and email address.
4. Choose your payroll deduction donation option. You can select annual giving, continued giving, or a one-time gift. Enter the appropriate amounts based on the options provided.
5. If opting for other donation methods like check or credit/debit card, fill in the required details including card number and expiration date. Ensure to sign where indicated for credit/debit transactions.
6. Indicate how you would like your gift to be used by selecting from the available options such as supporting the Friends of West Jeff Fund or Employee Assistance Fund.
7. Once completed, return your form to the Foundation Office or scan and email it to wjhfoundation@LCMChealth.org.

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