Tuition Deduction Authorization Form
I authorize the Payroll Department of Hampshire College to:
Deduct _____________% -per paycheck
For a total of $_______________ per school year
. (The limit cannot exceed $1000 per school year) year.)
Student Name: ________________________________ Student ID: _____________________________
Daytime Phone: _______________________________ Email: ___________________________________
Please return this form to the Payroll Office: located in Blair Hall, second floor, room 217. The hours of
operation are Monday through Friday 8:30AM-4:30PM (closed 11:45AM – 1:15PM)
Or
Student Employment: located in the Kern building, second floor room WS7. The hours of operations are
Monday through Friday 8:45AM-4:15PM (closed 11:45AM – 1:15PM)
Signature: ________________________________________________ Date: ___________________________
Date RCVD Student Employment: __________________ Date RCVD PR ___________________
Date of first check deduc
tion: _____________________
This Form is in effect for all paychecks dated between 09-02-2018 to 05-18-2019
This deduction is to be applied to my outstanding tuition balance. This will show on my pay stub as
SPTU. This deduction will automatically stop once my limit is reach. I can cancel my deduction at any
time by notifying Hampshire College Payroll via email: payroll@hampshire.edu
. If I wish to change or
update my information I must submit a new Tuition Deduction form.
Please sign with pen
