Submit your form: Complete and save this llable pdf. Submit by using the “Human Resources Form
Submission” Portal Channel. Upload the file under the headers “Current Employee –
Payroll” as “Payroll Deduction Authorization Form”. Human Resources will provide WOU
Foundation with a copy of your form once it’s completed. Submit by the 10th for deduction
to start that month.
PAYROLL DEDUCTION AUTHORIZATION FORM:
Employee name _____________________________________ ________________________ _____________________
(Please Print or Type) Last First Middle initial
Home address _______________________________________________________________________________________
V number __________________Work phone ___________________________ Department ______________________
PLEASE SELECT ONE:
This pledge will
o
be in addition to
o
replace all previous payroll deductions to the WOU Foundation
PLEASE SELECT ONE:
o
9-month employee
o
12-month employee
o
Student employee
THANK YOU FOR BEING A WOU SUSTAINER:
Start month___________
o
$100
o
$50
o
$25
o $85 (President’s Club)
o Other $__________
THIS GIFT WILL BE USED FOR:
o
Greatest need
o
Other (please designate) _____________________
___________________________________
WOU Foundation
F
or information: foundation@wou.edu
Thank you for your donation!
Employee Giving
ALL DONATIONS QUALIFY AS TAX DEDUCTIBLE CHARITABLE CONTRIBUTIONS
As provided in ORS 292.014, I hereby authorize the deduction from my pay each period the amount
designated above. Such amount is to be deposited with the WOU FOUNDATION. This deduction shall
continue until written notice is received from me by Human Resources (payroll@wou.edu).
Notice must be received by the 10th of the month to start or stop deduction.
Signature___________________________________________________________ Date____________________
The duties and obligations of the State of Oregon arising from this request shall be limited to the payment of the sum
designated to the WOU Foundation.
