Revised 11.29.16
EMPLOYEE GIVING PROGRAM
YCCD Payroll Deduction Form
Last Name First Name
Employee Number ____________ __ or SSN# (last 4 digits) ________________________
YCCD/CC Department: ___________________________
New Donor Current Donor-Revision (Current payroll donations are listed on your YCCD StaffNet account)
Donation Distribution
Please use my gift where it is needed most (unrestricted) $____________ Monthly
Other Designated Fund ______________________________ $____________ Monthly
$ ____________ TOTAL Monthly
Begin Payment __________ (Month) ___________ (Year)
(NOTE: This form must be received by the CCF by the 5
th
of the month preceding the first payroll deduction).
The Yosemite Community College District payroll office is hereby authorized to deduct from salary warrants due to
me the sum indicated for payment to the Columbia College Foundation. This authorization is to remain in force from
year to year until revoked or revised by me.
Date Signature
Complete and return to Columbia College Foundation, Manzanita 250, or scan and email to francisk@yosemite.edu
Questions? Contact the Foundation at 209.588.5065, nilsona@yosemite.ed or francisk@yosemite.edu
Routing procedure for this form:
CC Development/Foundation Office: Received __________
CC Business Office: Received __________
YCCD Payroll Office: Received __________
click to sign
signature
click to edit
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