SECA Pledge Form

This is the SECA payroll deduction donation form for the calendar year of 2025. Only State of Illinois Employees can use this form to donate. Payroll deductions will begin in January of 2025.

Contact Information

First Name

Middle Name

Last Name

Work Email

I would like to subscribe for future SECA Emails using the email provided.

I would like to remain anonymous from site recognition.

I would like to opt out of donation gifts and incentives.

Please provide at least one address.

Home Address

City

State

Zip Code

OR

Office Address

City

State

Zip Code

Agency/University

Payroll Contribution

I wish to contribute through SECA by payroll deductions the amounts shown below.
(A minimum of $2.00 per period is required to reduce administration cost.)

Select Charity

Amount Per Pay Period

$

Total Per Pay Period

$

X

Number of Pay Periods

=

Annual Payroll Deduction

$

I authorize my employer to deduct from my paycheck the amount recorded beginning with the January 2025 pay period.

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