Payroll Deduction Authorization for
Donation or EDF Membership:
Name___________________________________ Phone __________________________
Address: _________________________________ Email __________________________
City _________________ State ________ Zip Code ___________ TUID _____________
Employee #________________ Department ______________ Mail Code ____________
Payroll Deduction:
Create a NEW payroll deduction of $__________ per pay period
Change an existing payroll deduction from $ _______ to $_______
This deduction is designated for:
Foundation donation designated for:
Student Scholarships
Program Fund (specify fund) _______________________
Other (please specify) _____________________________
Employee Development Fund (EDF) Membership (min. $1 per pay period)
Special Instructions or Comments:
By typing my name in the box, I am submitting an electronic signature authorizing the
transaction listed above.
_______________________________ __________________________
Type in Name to Authorize Date
Any questions, contact Beth Vanderlip 483-1986, email:
Click to Submit By Email