giving.ochsner.org
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216.235.194.107
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Submitted URL: https://giving.ochsner.org/site/R?i=uH5ZduM5Bd_Gkc-BW9-fk092waDf1TszSe8359aP5RzKGrAu834aZg
Effective URL: https://giving.ochsner.org/site/SSurvey?ACTION_REQUIRED=URI_ACTION_USER_REQUESTS&SURVEY_ID=1520
Submission: On November 25 via manual from US — Scanned from DE
Effective URL: https://giving.ochsner.org/site/SSurvey?ACTION_REQUIRED=URI_ACTION_USER_REQUESTS&SURVEY_ID=1520
Submission: On November 25 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST https://giving.ochsner.org/site/SSurvey
<form method="POST" action="https://giving.ochsner.org/site/SSurvey" onsubmit="return checkDoubleClick();">
<div class="appArea ">
<h3 class="ObjTitle">OLG Employee Giving Form</h3>
<p></p>
</div>
<div class="appArea">
<table width="100%" border="0" cellspacing="4" cellpadding="0" class="personal_info_table">
<tbody>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td>
<!-- DO NOT EDIT THIS SECTION -->
<div class="OMSInstructions alter_text"><img id="" class="alter_img_default" style="display: block; margin-left: auto; margin-right: auto; margin-bottom: 20px;" src="../images/content/pagebuilder/OH_LeaveYourLegacy_Mark__1_.png"
alt="Leave Your Legacy Employee Giving" width="300px" height="auto">
<p class="OMSP OMSH3_initial" style="text-align: left;"><span id="alter_txt_default">Choose the area that you would like to support from the drop down below. Thank you for your thoughtful generosity!</span></p>
</div>
<!--<img src="https://giving.ochsner.org/C/Ochsner/Content/Images/UploadedImages/ImageGallery/OH_LeaveYourLegacy_Mark%20(003).png" alt="Leave Your Legacy Employee Giving" style="display: block; margin-left: auto; margin-right: auto;" width="477" height="156" class="alter_img">
<h1 class="OMSP OMSH3 alter_title" style="text-align: center;"></h1>
<p class="OMSP OMSH3_initial" style="text-align: center;"><a href="Donation2?df_id=1581&mfc_pref=T&1581.donation=form1" target="_blank">Please click here to make a direct one-time gift.</a> The deadline for donations by GPT and Payroll Deduction has passed.</p>
Our physicians and employees contribute meaningful gifts through the <a href="http://www.ochsner.org/giving/donate/employee-giving/">Leave Your Legacy Campaign</a> to support patient programs, employee assistance, nursing education and other areas of need. -->
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td>
<style>
body {
font-weight: 400;
}
select {
padding: 8px 7px;
}
@media screen only and (min-width: 768px) {
form {
margin: 0 auto;
width: 80%;
}
}
@media screen only and (max-width: 767px) {
form {
width: 100%;
}
}
h3.ObjTitle {
display: none;
}
.personal_info_table p.Smaller {
margin-bottom: 0;
}
#designee_type {
display: none !important;
}
</style>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td>
<!-- Designation filepath DO NOT EDIT -->
<hr>
<h2>Gift Designation</h2>
<p>Choose an area to support:</p>
<!-- CSV file path for designation, description, images link, etc.
../designation_parse_list2022/des_full_employee.csv
../designation_parse_list2022/OLG_FundDesignations.csv
../designation_parse_list2022/OLG_FundDesignations_survey_clean
updated on 11/20 from OLG_FundDesignations_survey_clean to OLG_FundDesignations.csv
OLG_FundDesignations_survey_clean.csv is working version when go live
-->
<!-- <div id="trigger_list" class="btn" onclick="">Click to choose an area to support ↓</div>
-->
<select name="designee_type" id="designee_type" size="1">
<option value="0">Select a Designation type</option>
<option value="Acadiana">Acadiana</option>
<option value="undefined">undefined</option>
</select>
<select id="desig_select_id" class="desig_select_class">
<option value="NOREPLY">Please select response</option>
<option desc="Donors to the Alcohol Abuse Prevention Fund support education and efforts to prevent alcohol abuse." image_link="" value="" type_name="Acadiana">Alcohol Abuse Prevention Fund</option>
<option desc="The Ochsner Lafayette General (OLG) Behavioral Health Fund supports behavioral health initiatives for individuals and families." image_link="OLGBehavioralHealth.jpg" value="1099" type_name="Acadiana">Behavioral Health Fund
</option>
<option desc="Gifts to the OLG Cardiology Innovation Fund support cardiology patient care, education, training, equipment and technology. " image_link="KRountree_OLGCardiologyInnovationFund.jpg" value="1277" type_name="Acadiana">
Cardiology Innovation Fund</option>
<option desc="The Dr. Jason Breaux Endowed Cancer Fund supports care for patients facing a cancer diagnosis." image_link="" value="1278" type_name="Acadiana">Dr. Jason Breaux Endowed Cancer Fund</option>
<option desc="The Greg Hebert Lung Cancer Screening Fund supports lung cancer screenings for patients in need of financial assistance." image_link="" value="1279" type_name="Acadiana">Greg Hebert Lung Cancer Screening Fund</option>
<option desc="The Imaging Center of Excellence Fund supports the efforts of Imaging at Ochsner Lafayette General." image_link="" value="" type_name="Acadiana">Imaging Center of Excellence Fund</option>
<option desc="The Jessie Naquin Pancreatic Research Endowment supports research and innovation." image_link="" value="1280" type_name="Acadiana">Jessie Naquin Pancreatic Research Cancer Fund</option>
<option
desc="The Ochsner Lafayette General (OLG) Maternal, Newborn & Pediatric Services Fund supports the health and well-being of mothers and children. Projects, including providing safe-sleep environments for newborns, help to strengthen families across Acadiana."
image_link="OLGMaternal.jpg" value="1101" type_name="Acadiana">Maternal, Newborn, and Pediatric Services Fund</option>
<option desc="The Metabolic and Bariatric Center of Excellence Fund supports the care of patients and innovations in the field of bariatrics. " image_link="" value="1276" type_name="Acadiana">Metabolic and Bariatric Center of Excellence
Fund</option>
<option desc="The Neurology Center of Excellence Fund supports care for patients with neurological disorders." image_link="" value="1281" type_name="Acadiana">Neurology Center of Excellence Fund</option>
<option
desc="You can make an impact on the future of healthcare in Acadiana by supporting the Ochsner Lafayette General (OLG) Nursing Education Fund. The Nursing Education Fund provides professional development opportunities to those interested in pursuing or advancing their nursing careers including: the Nurse Apprenticeship Program: Students pursuing their Medical Assistant (MA) to Licensed Practical Nurse (LPN) or Licensed Practical Nurse (LPN) to Registered Nurse (RN) degrees may apply for a paid apprenticeship with Ochsner Lafayette General and the Master of Nursing Scholarship: Awarded to current Ochsner Lafayette General nurses interested in earning their Master of Science in Nursing (MSN) degree. Your gift to the OLG Nursing Education Fund will help accelerate the education and professional skills of those who dedicate their lives to serve others."
image_link="OLGNursingAssistance-21_Ochsner_Ortho_20210929_pic_JamieOrillion__003-2.jpg" value="1102" type_name="Acadiana">Nursing Education Fund</option>
<option desc="Gifts to the Ochsner Cancer Center of Acadiana support oncology patient care, technology and equipment, and professional development." image_link="OncologyNursesPhoto_2022.jpg" value="1282" type_name="Acadiana">Ochsner
Cancer Center of Acadiana Fund</option>
<option desc="The Ochsner Lafayette General Breast Center Fund supports care for patients facing breast cancer." image_link="" value="1283" type_name="Acadiana">Ochsner Lafayette General Breast Center Fund</option>
<option
desc="The Ochsner Lafayette General Community Health Center supports the renovation and revitalization of the Ochsner Lafyette Genera Community Health Center. The center provides care to Medicaid and Medicare patients, and the underserved/uninsured within the Acadiana community. "
image_link="" value="" type_name="Acadiana">Ochsner Lafayette General Community Health Center</option>
<option desc="The Ochsner Lafayette General Community Mobile Clinic Fund will be used to purchase a mobile clinic to provide services to the underserved in the Acadiana community." image_link="" value="1284" type_name="Acadiana">Ochsner
Lafayette General Community Mobile Clinic</option>
<option desc="The Ochsner Lafayette General Emergency Response Fund provides support at times of natural disaster. " image_link="" value="" type_name="Acadiana">Ochsner Lafayette General Emergency Response Fund</option>
<option
desc="Gifts to support the Ochsner Lafayette General (OLG) Employee Assistance Fund have provided crucial support and timely resources. The OLG Employee Assistance Fund is used to support employees across Ochsner Lafayette General during times of intense need. Your support ensures that resources are always there when our employees need them most."
image_link="OLGEmployeeAssistance-20_Ochsner_LG_Crowley_20201217_pic_005.jpg" value="1100" type_name="Acadiana">Ochsner Lafayette General Employee Assistance Fund</option>
<option desc="Donors to the OLG Employee Scholarship Fund are helping to expand education and career opportunities through scholarships to current employees and/or their dependents." image_link="" value="1290" type_name="Acadiana">
Ochsner Lafayette General Employee Scholarship Fund</option>
<option desc="The Ochsner Lafayette General (OLG) Foundation Fund supports facility expansion and renovation projects, patient care initiatives and other areas of greatest need."
image_link="OLGEmployeeAssistance-20_Ochsner_LG_Crowley_20201217_pic_005.jpg" value="1291" type_name="Acadiana">Ochsner Lafayette General Foundation Fund</option>
<option desc="The Ochsner Lafayette General Medical Center Fund supports care at Ochsner Lafayette General. " image_link="" value="1285" type_name="Acadiana">Ochsner Lafayette General Medical Center Fund</option>
<option
desc="The Ochsner Lafayette General (OLG) Patient Assistance Fund helps to reduce the concern that comes from the unforeseen costs of a hospital stay. Things like communication, transportation, lodging and meals can become overwhelming for patients and their families. Thanks to your generosity, patients assisted by this fund can focus on healing and their families can focus on offering the best support possible. Thank you for helping patients receiving care at Ochsner Lafayette General through the OLG Patient Assistance Fund"
image_link="OLGPatientAssistance-Ochsner_LG_Campaign7300-2 (1).jpg" value="1103" type_name="Acadiana">Ochsner Lafayette General Patient Assistance Fund</option>
<option desc="The Ochsner Lafayette General Surgical Hospital Fund supports the efforts of surgery." image_link="" value="1287" type_name="Acadiana">Ochsner Lafayette General Surgical Hospital Fund</option>
<option desc="The Ochsner Orthopedic Center of Excellence Fund supports care for patients with orthopedic issues." image_link="" value="1288" type_name="Acadiana">Ochsner Orthopedic Center of Excellence Fund</option>
<option desc="The Ochsner St. Martin Hospital Fund supports the expansion of care in Acadiana." image_link="" value="1289" type_name="Acadiana">Ochsner St. Martin Hospital Fund</option>
<option desc="Donors to the Ochsner University Health & Clinics Fund help ensure care for all regardless of coverage financial status at Ochsner University Health & Clinics." image_link="" value="" type_name="Acadiana">Ochsner
University Health & Clinics Fund</option>
<option desc="The Ochsner Lafayette General Medical Center Fund supports education, patient care and the purchase of medical equipment to better serve patients at the Stroke Center." image_link="" value="1286" type_name="Acadiana">
Stroke Center Fund</option>
<option
desc="The Teaching Hospital Endowment supports the teaching hospitals of Ochsner Lafayette General: Ochsner University Hospital and Clinics and Ochsner Lafayette General Medical Center. Thank you for expanding opportunities for education in Acadiana. "
image_link="" value="1292" type_name="Acadiana">Teaching Hospital Endowment</option>
<option desc="The Trauma II Center Fund supports care at the level II Trauma Center." image_link="" value="1293" type_name="Acadiana">Trauma II Center Fund</option>
<option desc="undefined" image_link="undefined" value="" type_name="undefined">undefined</option>
</select>
<script type="text/javascript" src="../designation_parse_list2022/papaparse/papaparse.min.js"></script>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.11.1/jquery.min.js"></script>
<script>
//Using Convio YUI jQuery
Y.use('jquery-noconflict', function() {
jQuery(document).ready(function($) {
//if NOT testsurveypara, LIVE
/*$("#designee_type").hide();
$("#desig_select_id").hide();*/
$('#desig_select_id').addClass('desig_select_class');
$('#cons_info_component').parents('table').addClass('personal_info_table');
$('.personal_info_table').find('textarea').addClass('designee_textarea');
$('.designee_textarea').parent().parent().hide();
var destype_arr = [];
var newArr = [];
//jQuery('#cons_email').click(function(event) {
//jQuery('.personal_info_table :input').click(function(event) {
/* SA jQuery('#trigger_list').click(function(event) { */
//only load once
/*if($('#designee_type option').length < 2 ){
parseData('../designation_parse_list2022/des_full_employee.csv', doStuffAffiliate22);
}*/
parseData("../designation_parse_list2022/OLG_FundDesignations_survey_clean.csv", doStuffAffiliate22);
/*$("#designee_type").show();
$("#desig_select_id").show();*/
function doStuffAffiliate22(data) {
console.log('data=' + data);
var affiliate = data;
console.log('affiliate=' + affiliate);
var affiliateInfo = affiliate.length - 1;
//console.log('affiliateInfo=' + affiliateInfo);
for (var i = 0; i <= affiliateInfo; i++) {
var LO_DES_ID = affiliate[i].LO_DES_ID;
console.log('LO_DES_ID=' + LO_DES_ID);
var Fund_Name = affiliate[i].Fund_Name;
//console.log('Fund_Name=' + Fund_Name);
var designation_type_id = affiliate[i].designation_type_id;
//console.log('designation_type_id=' + designation_type_id);
//designation type
var public_name = affiliate[i].public_name;
console.log('public_name=' + public_name);
var image_link = affiliate[i].image_link;
console.log('image_link=' + image_link);
var description = affiliate[i].description;
//console.log('description=' + description);
//first dropdown populting
destype_arr.push(public_name);
//destype_arr.sort();
newArr = $.unique(destype_arr.sort()).sort();
//second dropdown value, value is public_name for type reference
$('#desig_select_id').append('<option desc="' + description + '" image_link="' + image_link + '" value="' + LO_DES_ID + '" type_name="' + public_name + '">' + Fund_Name + '</option>');
} // end of for
pr_sortArr(newArr);
} // end of function
function pr_sortArr(arr) {
console.log('arr=' + arr);
for (var j = 0; j < arr.length; j++) {
$('#designee_type').append('<option value="' + arr[j] + '">' + arr[j] + '</option>');
} // end for
} // end function
/* SA }); */ //end of trigger click/change
//jQuery('#designee_type').click(function(event) {
jQuery('#designee_type').change(function(event) {
var value = $('#designee_type option:selected').val();
var temp_ID = '#desig_select_id' + ' > option';
$(temp_ID).each(function() {
var temp = $(this).attr('type_name');
if (value == temp) {
$(this).show();
} else {
$(this).hide();
}
});
// parseData('../designation_parse_list2022/SampleUpload_Oshcner.csv', doStuffAffiliate);
/*
parseData('../designation_parse_list2022/des_full_employee.csv', doStuffAffiliate);
function doStuffAffiliate(data) {
//console.log('data='+data);
var affiliate = data;
//console.log('affiliate='+affiliate);
var affiliateInfo = affiliate.length - 1;
//console.log('affiliateInfo=' + affiliateInfo);
for (var i = 0; i < affiliateInfo; i++ ) {
var LO_DES_ID = affiliate[i].LO_DES_ID;
//console.log('LO_DES_ID=' + LO_DES_ID);
var Fund_Name = affiliate[i].Fund_Name;
//console.log('Fund_Name=' + Fund_Name);
var designation_type_id = affiliate[i].designation_type_id;
//console.log('designation_type_id=' + designation_type_id);
var public_name = affiliate[i].public_name;
//console.log('public_name=' + public_name);
var image_link = affiliate[i].image_link;
// console.log('image_link=' + image_link);
var description = affiliate[i].description;
// console.log('description=' + description);
//second dropdwn value, value is public_name for type reference
//$(desig_select_id).append('<option value="'+LO_DES_ID+'" type_name="'+public_name+'">' +Fund_Name+ '</option>');
$('#desig_select_id').append('<option value="'+LO_DES_ID+'" type_name="'+public_name+'">' +Fund_Name+ '</option>');
} // end for
}// end of doStuffAffiliate
*/
}); //click ('#designee_type').click(function(event) {
jQuery('.desig_select_class').change(function(event) {
var title_value2 = $('.desig_select_class option:selected').text();
var image_link_value2 = $('.desig_select_class option:selected').attr('image_link');
console.log('image_link_value2=' + image_link_value2);
var desc_value2 = $('.desig_select_class option:selected').attr('desc');
var temp_text = '<p>' + desc_value2 + '</p>';
var temp_text = '<span>' + desc_value2 + '</span>';
//SA jQuery(".alter_text p").hide();
jQuery(".alter_img").attr('src', image_link_value2);
jQuery(".alter_img").attr('alt', title_value2);
jQuery(".alter_title").text(title_value2);
if (temp_text != "") {
jQuery(".alter_img").next('span').remove();
jQuery(".alter_img").after(temp_text);
}
if (image_link_value2 != "") {
jQuery(".alter_img").attr('src', '../designation_parse_list2022/LuminateOnlinePhotos/' + image_link_value2);
jQuery(".alter_img").show();
} else {
jQuery(".alter_img").hide();
}
if (title_value2 != "") {
jQuery(".alter_title").text(title_value2);
jQuery(this).parents('.personal_info_table').find('textarea').text(title_value2);
jQuery("#alter_txt_default").hide();
}
}); // end click/change ('#designee_type').click(function(event) {
function parseData(url, callBack) {
//papa parse
console.log("parsing data function");
Papa.parse(url, {
download: true,
header: true,
complete: function(results) {
callBack(results.data);
} //complete function
});
} // end of parseData
// NOT TestSurveyPara End, LIVE
}); //jQuery
}); //YUI
</script>
<style>
#scrollable-dropdown-menu {
position: relative;
*z-index: 1;
}
#the-notification {
display: block;
font-weight: bold !important;
margin-bottom: 20px;
}
.tt-menu {
width: 100%;
margin: 12px 0;
padding: 8px 0;
background-color: #fff;
border: 1px solid #ccc;
border-radius: 8px;
-webkit-box-shadow: 0 5px 10px rgb(0 0 0 / 20%);
-moz-box-shadow: 0 5px 10px rgba(0, 0, 0, .2);
box-shadow: 0 5px 10px rgb(0 0 0 / 20%);
height: 210px;
overflow-y: scroll;
}
.twitter-typeahead {
width: 100%;
}
.tt-suggestion {
padding: 3px 20px;
font-size: 18px;
line-height: 24px;
}
#ProcessForm div.html-caption-container {
overflow: visible !important;
}
#typeAheadArea {
margin: 0px auto 39px auto;
}
#single_designee,
#designee_type {
display: block;
}
@media only screen and (max-width: 769px) {
#single_designee,
#designee_type {
max-width: 350px;
}
.masthead .wrapper {
margin: 20px;
margin-top: 100px;
}
}
.alter_img {
margin-bottom: 20px;
height: auto;
margin-right: 20px;
height: auto;
width: 150px;
display: none;
}
#single_designee optgroup option {
font-size: 14px;
}
input[type="text"],
input[type="number"],
input[type="password"],
input[type="select"],
input[type="option"],
input[type="email"],
input[type="tel"],
textarea,
select {
border-radius: 0;
}
#trigger_list {
border: 1px solid #ccc;
}
@media only screen and (max-width: 480px) {
tr.old-school td {
max-width: 350px;
}
}
p.OMSP span {
text-align: left;
}
</style>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td style="display: none;">
<label class="wrapable" for="6278_1520_5_1484">
<span class="aural-only" style="position: absolute; left: -9999px;"> Question - Not Required - </span>
<span class="Explicit"> Designee Text Field </span>
</label>
<br>
<span class="NetscapeFix"><textarea cols="50" rows="5" name="6278_1520_5_1484" id="6278_1520_5_1484" onkeyup="limitArea(this, 255, 'Error: This text area is limited to 255 characters. Please modify your text accordingly.')"
class="designee_textarea"></textarea></span><br>
<span class="Hint">(Maximum response 255 chars, approx. 5 rows of text)</span><br><br>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td>
<hr>
<h2>Type of Gift</h2>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap">
<span class="req true" title="Required">*</span>
</td>
<td>
<fieldset>
<legend class="surveyLegend Explicit">
<span class="legendWrapper" style="display:block; white-space:normal; width:100%;">
<span class="aural-only" style="position: absolute; left: -9999px;"> Question - Required - </span>
<span>Please choose one of the following:</span>
</span>
</legend>
<span class="NetscapeFix">
<div style="display: flex; flex-direction: row; margin: 5px 5px 5px 0;">
<input type="radio" name="6278_1520_7_1486" id="6278_1520_7_1486_1" class="radio" value="Make this a payroll deduction (bi-weekly)" style="margin-right: 5px;">
<span class="Explicit"><label class="wrapable" for="6278_1520_7_1486_1">Make this a payroll deduction (bi-weekly)</label></span>
</div>
<div style="display: flex; flex-direction: row; margin: 5px 5px 5px 0;">
<input type="radio" name="6278_1520_7_1486" id="6278_1520_7_1486_2" class="radio" value="Donate the cash value of GPT/Vacation hours (enter the number of hours below)" style="margin-right: 5px;">
<span class="Explicit"><label class="wrapable" for="6278_1520_7_1486_2">Donate the cash value of GPT/Vacation hours (enter the number of hours below)</label></span>
</div>
</span>
<br>
</fieldset>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td>
<div id="footer-survey_text">
<p style="margin-top: -1.5em;"> </p>
<p style="margin-top: -1.5em;">*Your <strong>payroll deduction</strong> will automatically continue every year, and you will not need to take any further action unless you choose to opt-out by contacting the Physician and Employee
Giving team at employeegiving@ochsner.org.</p>
<p style="margin-top: -1.5em;"> </p>
<p style="margin-top: -1.5em;"> </p>
<p style="margin-top: -1.5em;"><span>*Rush Legacy hours cannot be donated.</span></p>
<p style="margin-top: -1.5em;"> </p>
<p style="margin-top: -1.5em;"> </p>
<p style="margin-top: -1.5em;"><a href="Donation2?df_id=1782&mfc_pref=T&1782.donation=form1" target="_blank">Please click here to make a direct one-time gift.</a> </p>
</div>
<hr>
<h2>Gift Amount</h2>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap">
<span class="req true" title="Required">*</span>
</td>
<td>
<label class="wrapable" for="6278_1520_10_1488">
<span class="aural-only" style="position: absolute; left: -9999px;"> Question - Required - </span>
<span class="Explicit"> Amount: (Enter the number of hours or the bi-weekly payroll deduction amount) </span>
</label> <br>
<span class="NetscapeFix"><input type="text" name="6278_1520_10_1488" id="6278_1520_10_1488" value="" size="30" maxlength="40"></span>
<br><br>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td>
<p>For payroll deduction, enter the bi-weekly payroll deduction amount and not the total yearly amount.</p>
<hr>
<h2>Gift Options:</h2>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td>
<label class="wrapable" for="6278_1520_12_1490">
<span class="aural-only" style="position: absolute; left: -9999px;"> Question - Not Required - </span>
<span class="Explicit"> Would you like to remain anonymous from public recognition? </span>
</label>
<br>
<span class="NetscapeFix">
<select name="6278_1520_12_1490" id="6278_1520_12_1490" onchange="choiceSelected('6278_1520_12_1490', this.selectedIndex);">
<option value="NOREPLY">Please select response</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</span><br><br>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td>
<hr>
<h2>Personal Information</h2>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td>
<span class="Explicit">Please fill out your personal information below (required):</span><br>
<table border="0" cellspacing="4" cellpadding="0" class="personal_info_table">
<tbody>
<tr style="position:absolute;left:-9999px">
<td colspan="3">
<input type="hidden" name="cons_info_component" id="cons_info_component" value="t">
</td>
</tr>
<tr valign="bottom">
<td width="1%">
<p>*</p>
</td>
<td nowrap="nowrap">
<p>Name:</p>
</td>
<td>
<table border="0" cellspacing="0" cellpadding="0">
<tbody>
<tr>
<td>
<p class="Smaller"><label for="cons_first_name">First <span style="position:absolute;left:-9999px">Required</span></label> </p>
</td>
<td>
<p class="Smaller"><label for="cons_last_name">Last <span style="position:absolute;left:-9999px">Required</span></label> </p>
</td>
</tr>
<tr valign="top">
<td class="NetscapeFix" nowrap="nowrap">
<input type="text" name="cons_first_name" id="cons_first_name" value="" size="21" maxlength="50">
</td>
<td class="NetscapeFix" nowrap="nowrap">
<input type="text" name="cons_last_name" id="cons_last_name" value="" size="22" maxlength="50">
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td width="1%">
<p>*</p>
</td>
<td nowrap="nowrap">
<p><label for="cons_email">Email: <span style="position:absolute;left:-9999px">Required</span></label></p>
</td>
<td>
<input type="email" name="cons_email" id="cons_email" value="" size="45" maxlength="255">
</td>
</tr>
<tr>
<td width="1%">
<p>*</p>
</td>
<td>
<p><label for="cons_street1">Street 1: <span style="position:absolute;left:-9999px">Required</span></label></p>
</td>
<td>
<input type="text" name="cons_street1" id="cons_street1" value="" size="45" maxlength="128">
</td>
</tr>
<tr valign="bottom">
<td width="1%">
<p>*</p>
</td>
<td>
<p>City/State/ZIP:</p>
</td>
<td>
<table border="0" cellspacing="0" cellpadding="0">
<tbody>
<tr>
<td>
<p class="Smaller"><label for="cons_city">City <span style="position:absolute;left:-9999px">Required</span></label></p>
</td>
<td>
<p class="Smaller"><label for="cons_state">State <span style="position:absolute;left:-9999px">Required</span></label> </p>
</td>
<td>
<p class="Smaller"><label for="cons_zip_code">ZIP <span style="position:absolute;left:-9999px">Required</span></label></p>
</td>
</tr>
<tr valign="top">
<td class="NetscapeFix" nowrap="nowrap">
<input type="text" name="cons_city" id="cons_city" value="" size="22" maxlength="64">
</td>
<td class="NetscapeFix" nowrap="nowrap"><select name="cons_state" id="cons_state" size="1">
<option></option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="AS">AS</option>
<option value="FM">FM</option>
<option value="GU">GU</option>
<option value="MH">MH</option>
<option value="MP">MP</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="VI">VI</option>
<option value="AA">AA</option>
<option value="AE">AE</option>
<option value="AP">AP</option>
<option value="AB">AB</option>
<option value="BC">BC</option>
<option value="MB">MB</option>
<option value="NB">NB</option>
<option value="NL">NL</option>
<option value="NS">NS</option>
<option value="NT">NT</option>
<option value="NU">NU</option>
<option value="ON">ON</option>
<option value="PE">PE</option>
<option value="QC">QC</option>
<option value="SK">SK</option>
<option value="YT">YT</option>
<option value="None">None</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('cons_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('cons_state_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
</td>
<td class="NetscapeFix" nowrap="nowrap">
<input type="text" name="cons_zip_code" id="cons_zip_code" value="" size="10" maxlength="40">
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td width="1%">
<p>*</p>
</td>
<td>
<p><label for="cons_country">Country: <span style="position:absolute;left:-9999px">Required</span></label></p>
</td>
<td class="NetscapeFix">
<select name="cons_country" id="cons_country" size="1">
<option></option>
<option selected="selected" value="United States">United States</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivarian Republic of Venezuela">Bolivarian Republic of Venezuela</option>
<option value="Bonaire, Sint Eustatios and Saba">Bonaire, Sint Eustatios and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote D'Ivoire">Cote D'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curacao">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Democratic People's Republic of Korea">Democratic People's Republic of Korea</option>
<option value="The Democratic Republic of the Congo">The Democratic Republic of the Congo</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Federated States of Micronesia">Federated States of Micronesia</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="The Former Yugoslav Republic of Macedonia">The Former Yugoslav Republic of Macedonia</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Islamic Republic of Iran">Islamic Republic of Iran</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Plurinational State of Bolivia">Plurinational State of Bolivia</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Republic of Korea">Republic of Korea</option>
<option value="Republic of Moldova">Republic of Moldova</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French)">Saint Martin (French)</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="S. Georgia & S. Sandwich Isls.">S. Georgia & S. Sandwich Isls.</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch)">Sint Maarten (Dutch)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan, Province of China">Taiwan, Province of China</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United Republic of Tanzania">United Republic of Tanzania</option>
<option value="Uruguay">Uruguay</option>
<option value="USA Minor Outlying Islands">USA Minor Outlying Islands</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands (British)">Virgin Islands (British)</option>
<option value="Virgin Islands (USA)">Virgin Islands (USA)</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('cons_country', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('cons_country_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
</td>
</tr>
<tr>
<td width="1%">
<p> </p>
</td>
<td>
<p><label for="cons_phone">Phone Number: </label></p>
</td>
<td>
<input type="tel" name="cons_phone" id="cons_phone" value="" size="15" maxlength="50">
</td>
</tr>
<tr>
<td width="1%">
<p> </p>
</td>
<td colspan="2">
<input type="hidden" name="cons_mail_opt_in" id="cons_mail_opt_in" value="t">
<input type="checkbox" name="cons_email_opt_in" id="cons_email_opt_in" checked="checked">
<label for="cons_email_opt_in" class="wrapable">
<span class="Explicit">Please check this box to receive or continue receiving periodic email updates from Ochsner Philanthropy about the impact of your generosity.</span></label>
<input type="hidden" id="cons_email_opt_in_requested" name="cons_email_opt_in_requested" value="true">
</td>
</tr>
<tr>
<td width="1%">
<p> </p>
</td>
<td colspan="2">
<input type="checkbox" name="s_rememberMe" id="s_rememberMe" checked="checked">
<input type="hidden" id="remember_me_opt_in_requested" name="remember_me_opt_in_requested" value="true">
<label for="s_rememberMe" class="wrapable">
<span class="Explicit">Keep me logged in.</span>
</label>
<a href="#" id="whats_this_link">What's this?</a>
<script>
Y.use("jquery-qtip2", "jquery-qtip2-css", function(Y) {
jQuery('#whats_this_link').click(function() {
jQuery('#whats_this_link').qtip({
style: {
classes: 'qtip-light'
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show: {
ready: true
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hide: {
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hide: {
fixed: true,
event: 'click unfocus'
},
content: {
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});
return false;
});
});
</script>
<div id="whats_this_tooltip" style="display: none;">
<span id="whats_this_tooltip_text">Remembers your login information for your convenience. Use only on trusted, private computers.</span>
<p>
<a id="whats_this_tooltip_link" onclick="javascript:MM_openBrWindow('http://giving.ochsner.org/site/PageServer?pagename=privacypolicy&printer_friendly=1','Description','toolbar=no,scrollbars=yes,resizable=yes,alwaysRaised=yes,dependent=yes,width=700,height=500'); return false;" href="http://giving.ochsner.org/site/PageServer?pagename=privacypolicy&printer_friendly=1" title="View Privacy Policy (opens separate window)" target="_blank">Privacy Policy</a>
</p>
</div>
</td>
</tr>
</tbody>
</table>
<br>
</td>
</tr>
<tr valign="top" class="old-school">
<td width="5%" class="req" align="right" nowrap="nowrap"> </td>
<td>
<div id="footer-survey_text">
<p>If you do not see the fund you would like to support, please click
<a href="https://ochsnerhealth.sharepoint.com/sites/Culture/SiteAssets/Forms/AllItems.aspx?id=%2Fsites%2FCulture%2FSiteAssets%2FSitePages%2FEmployee%2DGiving%2FOLGPledgeForm2024DRAFT%2Epdf&parent=%2Fsites%2FCulture%2FSiteAssets%2FSitePages%2FEmployee%2DGiving" target="_blank">here</a>.
</p>
</div>
</td>
</tr>
</tbody>
</table>
</div>
<div class="appArea ">
</div>
<div style="display:none">
<label for="denySubmit">Spam Control Text:</label> <input type="text" name="denySubmit" id="denySubmit" value="" alt="This field is used to prevent form submission by scripts."> Please leave this field empty
</div>
<div class="appArea ">
<p>
<input type="submit" name="ACTION_SUBMIT_SURVEY_RESPONSE" id="ACTION_SUBMIT_SURVEY_RESPONSE" value="Submit" class="Button"> <input type="reset" name="reset" id="reset" value="Reset Answers" class="Button"> <input
type="submit" name="ACTION_CANCEL_RESPONSE_SUBMIT" id="ACTION_CANCEL_RESPONSE_SUBMIT" value="Skip" class="Button">
</p>
</div>
<input type="hidden" name="SURVEY_ID" id="SURVEY_ID" value="1520">
<script type="text/javascript">
var submitted = false;
function checkDoubleClick() {
if (submitted) {
alert('You have already submitted this form. Please wait...');
return false;
} else {
submitted = true;
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}
}
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Thank you for your thoughtful generosity! -------------------------------------------------------------------------------- GIFT DESIGNATION Choose an area to support: Select a Designation type Acadianaundefined Please select response Alcohol Abuse Prevention FundBehavioral Health FundCardiology Innovation FundDr. Jason Breaux Endowed Cancer FundGreg Hebert Lung Cancer Screening FundImaging Center of Excellence FundJessie Naquin Pancreatic Research Cancer FundMaternal, Newborn, and Pediatric Services FundMetabolic and Bariatric Center of Excellence FundNeurology Center of Excellence FundNursing Education FundOchsner Cancer Center of Acadiana FundOchsner Lafayette General Breast Center FundOchsner Lafayette General Community Health CenterOchsner Lafayette General Community Mobile ClinicOchsner Lafayette General Emergency Response FundOchsner Lafayette General Employee Assistance FundOchsner Lafayette General Employee Scholarship FundOchsner Lafayette General Foundation FundOchsner Lafayette General Medical Center FundOchsner Lafayette General Patient Assistance FundOchsner Lafayette General Surgical Hospital FundOchsner Orthopedic Center of Excellence FundOchsner St. Martin Hospital FundOchsner University Health & Clinics FundStroke Center FundTeaching Hospital EndowmentTrauma II Center Fundundefined Question - Not Required - Designee Text Field (Maximum response 255 chars, approx. 5 rows of text) -------------------------------------------------------------------------------- TYPE OF GIFT * Question - Required - Please choose one of the following: Make this a payroll deduction (bi-weekly) Donate the cash value of GPT/Vacation hours (enter the number of hours below) *Your payroll deduction will automatically continue every year, and you will not need to take any further action unless you choose to opt-out by contacting the Physician and Employee Giving team at employeegiving@ochsner.org. *Rush Legacy hours cannot be donated. 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