Fillable P D A I hereby authorize the Sacred (Sacred Heart University)

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P D A I hereby authorize the Sacred (Sacred Heart University)

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P
AYROLL
D
EDUCTION
A
UTHORIZATION
Upon completion, return form to Todd Gibbs, W3-L309, University Advancement.
Name: ID #
Department: Choose One:
❑
Faculty
❑
Staff
Phone number: ( )_ Email:
C
HOOSE
O
NE
:
❑
New payroll deduction
❑
Replacement to a current deduction
I hereby authorize the Sacred Heart University Payroll Office to deduct $_ .00 per paycheck. I understand
that all payroll deductions will begin with the soonest available pay period and remain in effect until I notify
University Advancement and/or Payroll of my intent to change or stop. Cancelation of this deduction must be
done in writing or email.
P
LEASE INDICATE BELOW HOW YOU WOULD LIKE TO DISTRIBUTE YOUR GIFT PER PAYCHECK
.
The Fund for Excellence
❑
Area of Greatest Need
$ .00
per paycheck.
❑
General Scholarship
$ .00
per paycheck.
❑
Community Service
$ .00
per paycheck.
Athletics
❑
Pioneer Club (General Support of SHU Athletics) or D1 Team
$ .00
per paycheck.
❑
Specific NCAA Division 1 Team
$ .00
per paycheck.
❑
Specific SHU Club Sport Team
$ .00
per paycheck.
College of “Dean’s Funds”
❑
College of Arts & Sciences
$ .00
per paycheck.
❑
College of Health Professions
$ .00
per paycheck.
❑
College of Nursing
$ .00
per paycheck.
❑
Isabelle Farrington College of Education
$ .00
per paycheck.
❑
Jack Welch College of Business
$ .00
per paycheck.
❑
Dean’s Diversity Scholarship Fund
$ .00
per paycheck.
Additional Giving Opportunities
❑
Frances Grodzinsky School of Computing Scholarship
$ .00
per paycheck.
❑
Matthew Dalling Irish Cultural Studies Endowed Scholarship
$ .00
per paycheck.
❑
Chapel of the Holy Spirit Fund
$ .00
per paycheck.
❑
Ryan Matura Library Fund
$ .00
per paycheck.
❑
Other Specified Purpose
$ .00
per paycheck.
S
IGNATURE
D
ATE
All gifts made in support of Sacred Heart University are tax-deductible to the extent allowed by law.
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Last updated: January 15, 2019
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P D A I hereby authorize the Sacred (Sacred Heart University)

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Completed 25 August 2020

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