PAYROLL DEDUCTION FORM
FOR A DONATION TO
THE CHABOT COLLEGE CLASSIFIED SENATE
I authorize the Chabot-Las Positas Community College District Payroll Department to
deduct $ ___________ from my monthly paycheck as a contribution to the Chabot College
Classified Senate.
I would like to change the amount of my current monthly contribution to the Chabot
College Classified Senate from $ ___________ to $ ___________ and authorize the Chabot-Las
Positas Community College District Payroll Department to deduct this adjusted amount
from my monthly paycheck.
I would like to cancel my contribution to the Chabot College Classified Senate.
I understand that my monthly payroll deduction will continue until the District Payroll
Department receives my signed notification of cancellation.
________________________________________________ ________________________________________________
Employee Name Employee ID or Social Security Number
________________________________________________ ________________________________________________
Signature Date
Note: Requests submitted by the 15
th
of the month should reflect on the employee’s next paycheck.
PLEASE SUBMIT THIS FORM TO CHRISTINE HERRERA, PRESIDENT’S OFFICE (x6641).
click to sign
signature
click to edit
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