Colby-Sawyer College

 

Faculty/Staff Payroll Deduction Form



First Name:
Last Name:
Title/Dept.:
Ext.
E-mail:
Home Address:
City:
State:
Zip:
Home Phone:


I authorize the following payroll deduction:

Please select one option:
  • A onetime deduction of $
  • A deduction of $ per pay period for a total gift of $
  • A deduction of $ per pay period until this date: (mm-dd-yyyy)
  • A deduction of $ per pay period until I submit a change.


Please designate my gift as:

UnrestrictedCampus Maintenance
ScholarshipsCampus Sustainability
Library SupportFaculty and Staff Enrichment
Student LifeTechnology
Teaching and LearningPresidential Initiatives
Other:


I wish for this gift to remain anonymous.



Comments or additional instructions (optional):

By checking this box I give my permission for Colby-Sawyer College to make deductions from my payroll according to the terms indicated above.