Payroll Deduction Form

Please complete and submit the information below to authorize the Madison College Foundation to set up a payroll deduction on your behalf.

Gift type*
Name*
First Last
Employee ID*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Enter Yearly Amount*
This deduction will continue until we are notified that you would like your deduction to terminate.
Gift Designation*
- Best Use
- Adopt a Scholar/Scholars of Promise
- Smart Future Scholarship
- Give to an Existing Scholarship
- Other
Enter Scholarship Name
Enter Other Designation
Notes
Please Check to Confirm*
- I authorize Madison College Foundation to set up this payment on my behalf.
Signature (type your full name)*