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)*

We are here to help answer your questions and provide assistance finding the most effective way for you to help future students.

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