Fillable Idaho State University Employee Payroll Deduction Authorization Form

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Idaho State University Employee Payroll Deduction Authorization Form

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EMPLOYEE PAYROLL DEDUCTION AUTHORIZATION
This form is intended for use by ISU employees and should only be used for gifts to ISU programs supported through
the ISU Foundation. If you have questions, please call (208) 282-3470.
By submitting this form, I understand that I am authorizing the ISU Payroll Office to make a payroll deduction for the designation(s) listed. This form will be processed
upon receipt and may take up to two (2) pay periods to process. This authorization will remain in effect until the pledge is fulfilled, cancelled in writing, or upon
termination of employment with Idaho State University. All changes of this authorization must be made in writing.
DONOR INFORMATION
Name:
Bengal ID:
Spouse:
Department:
City:
State:
Zip:
City:
State:
Zip:
Email:
I am an ISU alumnus/a:
Graduation Year:
GIFT INFORMATION
☐ New Payroll Deduction
☐ Replace Existing Payroll Deduction
☐ Add to My Existing Payroll Deduction
Designation
Deduction
Per Pay Period
# of Pay
Periods
Total
Total Gift:
Additional Comments: (note if gift should continue in perpetuity or until cancelled in writing)
AUTHORIZATION
I hereby request and authorize the Idaho State University Payroll Office to deduct the amount(s) designated above from
my paycheck each pay period, and to remit the withheld amount(s) to the Idaho State University Foundation.
Signature
Date
ISU FOUNDATION USE
Viking #:
Date Received:
Pledge
Transaction #:
Date Submitted
to Payroll Office:
Completed Form Should be Returned to the ISU Foundation.
Revised 4/2015
$ 0.00
$ 0.00
$ 0.00
$ 0.00
No
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Idaho State University Employee Payroll Deduction Authorization Form

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Completed 14 April 2020

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