• Home
• About CSECC
• Resource Guide
• Forms
  • Pledge Form
  • Information for American Humanics Donations
  • How to complete form
• Results
• FAQ
• Site Map

Instructions For Completing the Pledge Form

Mandatory entries are underlined.
Use ballpoint pen.

Click here to download instructions

I. IF YOU ARE A NEW DONOR:

1. Enter your social security number in box (1) and check the box in section (A).
2. Enter 028 in (6) for your donation to stay in Fresno County. If you want a different county (PCFD) see code numbers on the reverse side of the pledge form.
3. Enter Total monthly contribution.
4. To designate an organization to receive your contribution, see instruction (V).
5. Sign and date in section (F). Also, sign and date in (J) if you complete section G.

II. IF YOU ARE A NEW DONOR AND WANT TO CONTRIBUTE ONE TIME ONLY:

1. Check the box in section (H) and enter the amount of donation in (H).
2. Make check payable to CSECC.
3. Complete section (G) if you want to designate an organization. See instruction (V).
4. If you do step 3, you must sign and date in section (J).

III. IF YOU DO NOT WANT TO CHANGE THE AMOUNT OF YOUR EXISTING DONATION:

1. Check the box in section (E).
2. Sign and date in section (F). If you are changing your designation, see instruction (V).

IV. IF YOU WANT TO CHANGE THE AMOUNT OF YOUR EXISTING DONATION

1. Enter your social security number in box (1).
2. Check the box in section (B) and enter the total amount of the monthly payroll deduction.
3. This will cancel all previous designations. If you want to designate, you will have to complete section (G), even if you choose designations you had previously. (SEE INSTRUCTION V)
4. Sign and date in section (F). Also, sign and date in (J) if you complete section G.

V. IF YOU WANT TO DESIGNATE A NON-PROFIT TO RECEIVE YOUR CONTRIBUTION:

1. Check the box in section (G).
2. Enter organization(s) name, the organization’s code (from the campaign booklet), and the amount for each organization you are designating.
3. If the 501(c)(3) non-profit that you want to contribute to is not listed in the resource guide, Write-in organization information (name & address are a must; tax ID if you have it) in the space provided, and enter the amount.
4. TOTAL ALL Monthly Designations.
5. Sign and date in (J), in addition to (F).

VI. IF YOU WANT TO DONATE TO A SPECIFIC NON-PROFIT FOR 1 YEAR ONLY:

1. Check the box in the last column in section (G) next to your designation.

VII. IF YOU WANT TO DELETE YOUR EXISTING DONATION:

1. Enter your social security number in box (1).
2. Check the box in section (C).
3. Sign and date in section (F).

VII. IF YOU WANT TO NOT CONTRIBUTE:

1. Check the box in section (K) and initial.

IX. IF YOU WANT TO RECEIVE AN ACKNOWLEDGEMENT OF YOUR DONATION:

1. Complete section (I).

Complete instructions are on the reverse side of pledge form.