Pledge Form

When the SEFA 2015 campaign begins, you will receive a personalized packet containing a SEFA brochure, letters of support, and a pledge form.  This pledge form will already be labeled with your name and Employee I.D.

In the event that you lose your original pledge form, however, you can feel free to download and print this general SEFA Pledge Form.

SEFA Pledge Form Directions:

NAME:  Your first and last name as it appears on your paycheck.

NYS EMPLID:  This is your employee I.D. number.  You can find it on the top of your pay stub, in the middle section, 3 lines down under your name.  Do not use your Social Security Number.

FEDERATED FUND CODE:  The Federated Fund Code is the number that indicates the county in which you work.  For example, those who work in Albany County would use code 850 and those who work in New York City would use 851.  Even if you live in a different county than the county in which you work, you should still use the Federated Fund Code that represents your workplace.

AGENCY ZIP CODE:  The zip code for Geneseo, NY is 14454.

MY CONTRIBUTION METHOD:  Please select either payroll deduction or check and the amount you would like to contribute.  SEFA is no longer accepting cash contributions.  If you choose payroll deduction, you must also choose the amount you want deducted from each paycheck.

DESIGNATED AND UNDESIGNATED GIFTS:  If you do not designate a charity, your gift will be distributed on a pro-rata basis in accordance with 9 NYCRR 335.10.  However, if you choose to designate a particular charity, you will need to look up the organization's number and enter it into this section.