Payroll Gift Deduction Authorization Form
OCC 18 12/11
I hereby authorize the Payroll Department of Oakland Community College to deduct from my wages my tax-deductible donation to the Oakland
Community College Foundation in the following amount each pay period (minimum of $5 per pay period) :
AMOUNT PER PAY OCC EMPLOYEE NUMBER OCC CAMPUS/WORKSITE
Choose one of the following options:
Continue my donations (deductions) until further notice. Limit my donation to number of pay periods (minimum of 26).*
Purpose of gift:
Greatest need Specic purpose or scholarship fund
Administration Classied Faculty Maintenance
Management Staff Operating Engineers Public Safety
Employee Name (type or print)
Employee Signature Date
Please send completed, signed form to the OCC Foundation House.
Questions? Contact the OCC Foundation at extension 2137 or firstname.lastname@example.org.
*You will be contacted to renew your payroll deduction a month prior to the expiration date.
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