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:
Unrestricted
Campus Maintenance
Scholarships
Campus Sustainability
Library Support
Faculty and Staff Enrichment
Student Life
Technology
Teaching and Learning
Presidential 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.