Set Up a Payroll Deduction

Name*

First Last

Employee ID*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Deduction will begin the pay period following submission of this form.

Gift Designation (Check one or more boxes below)*

Best Use
Smart Future Scholarship (A general scholarship fund to support students from all program areas)
Scholars of Promise
Give to an Existing Scholarship
Other

Enter Scholarship Name

Include the name to one or more scholarship funds you wish to designate your gift to.

Enter Other Designation

Enter Amount Per Pay Period*

This deduction will continue until we are notified that you would like your deduction to terminate. To terminate, please use the "stop a deduction" form.

Notes

If multiple designations were selected, please use the notes section above to indicate amount per fund.

Please Check to Confirm*

I authorize Madison College Foundation to set up this payment on my behalf.

Signature (type your full name)*

Set up a Payroll Deduction

Deduction will begin the pay period following submission of this form.