Payroll Deduction Authorization Form

* Name:

* Phone:

* Address:

* Email:

* City:

* State:

* Zip:

* TUID/Username:

* 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

Foundation Donation Designated for Program Fund (specify fund)  

Foundation Donation 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


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Any questions, contact Beth Vanderlip 483-1986, email: