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Hillsboro Medical Healthcare Foundation supports Hillsboro Medical Center, an OHSU Partner, by funding projects and programs that enrich the patient experience and wellness of our community. Thank you for making a gift through payroll deduction.

Please complete the information below. Questions? Contact 503-681-1285.

Employee Giving

I wish to donate the following per pay period:

$2
$5
$10
$20
$30
$40
$50
$100
$200
Other

Other:

Please equally distribute my donation to the following fund(s) (no less than $1 per fund when equally distributed, please):*

Greatest Need

Emergency Department Upgrade

Dick Stenson Healthy Community/Patient Assistance

Cancer Care

Employee Food Pantry

¡Salud! Services

Spiritual Care Outreach / Music Therapy

Women's & Children's/NICU

*Please select one or more values

Employee number:*

*Please enter a value

Department:*

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Last four digits of SSN:*

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I would like to remain anonymous:

Yes

I understand that all previously submitted employee campaign forms are void and this donation will be considered most current. I understand that my donation is continuous and that I may cancel or make changes to the gift amount or fund designation at any time:*

Yes

*Please enter a value

Contact Information

Company:

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First Name:*

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Middle Name:

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Last Name:*

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Address:*

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Address2:

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City:*

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State:*

Province State is required for the United States

Postal Code:*

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Country / Location:*

Country is Required

At least one phone number is required.* Please enter at least one phone number

Mobile Phone:

Please enter a value for Mobile Phone: Please enter a valid phone number. Use x to denote extension

Home Phone:

Please enter a value for Home Phone: Please enter a valid phone number. Use x to denote extension

Work Phone:

Please enter a value for Work Phone: Please enter a valid phone number. Use x to denote extension

Email:*

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