Fillable Payroll Deduction Donation

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Payroll Deduction Donation

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REQUIRED
March 2019/PR
Payroll Deduction Donation
MCC faculty, staff and alumni coming together to raise funds for student scholarships.
PERSONAL INFORMATION
METHOD OF PAYMENT
First Name MI Last Name
Complete this donation form, sign, date and return to Institutional Advancement, Student Services Center, L231, or mail to MCC Foundation Scholarships, MS #6, Great Path, P.O.
Box 1046, Manchester, CT 06045-1046. MCC Foundation, Inc. is a 501(c)3 non-profit organization. Your gift is tax deductible to the extent allowed by law.
Street Address Apt. No.
City State Zip
Cell Phone Home Phone Email
Department
n
I authorize Manchester Community College to deduct the amount indicated below from my paycheck.
n
Deduct recurring gift of $_____________ per pay period
n
Change my current payroll deduction to $_____________ per pay period
n
Deduct a one-time gift of $_____________ from my next paycheck.
n
Make my donation anonymous
Date
Signature
If MCC grad, grad year Please select one
n
Full-time
n
Part-time
Please select one
n
Faculty
n
Staff
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Payroll Deduction Donation

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Completed 25 July 2020

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