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*
- This is a new payroll deduction
- Please update my current deductions to the specifications below
Name*
First Last
Employee ID*
Position ID #*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Enter Yearly Amount*
This deduction will terminate at the end of the calendar year unless auto-renew is selected.
I would like my pledge to auto renew.*
- Yes
- No
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
Please Check to Confirm*
- I authorize Madison College Foundation to set up this payment on my behalf.
Signature (type your full name)*

Foundation Centre
3591 Anderson Street, Suite 203A
Madison, WI 53704

Phone: 608-246-6441
Fax: 608-246-6318
Email: foundation@madisoncollege.edu