CCSU Foundation Payroll Deduction Agreement

Payroll Deduction Agreement and Authorization to make a gift to the
CCSU Foundation, Inc.
To enroll in payroll deduction
I, First Name Last Name, hereby request Central Connecticut State University to deduct from my biweekly salary a total of $Amount and to forward this amount to the CCSU Foundation, Inc. Unless otherwise specified below, this is to take effect beginning with the next available check date as determined by the CCSU Payroll Department.
Stop my current payroll deduction
How would you like your gift to benefit CCSU?
I would like $Amount of my deduction to benefit
I would like $Amount of my deduction to benefit
I would like $Amount of my deduction to benefit
I would like $Amount of my deduction to benefit
I would like $Amount of my deduction to benefit
I would like $Amount of my deduction to benefit
This Agreement is legally binding and irrevocable for both the Institution and the Employee with respect to amounts paid while this Agreement is in effect. This Agreement will be in effect unless notified by the employee to change amount deducted or to discontinue. The Employer may terminate this Agreement at any time. Such termination will be processed in the next available payroll cycle.
I have read and accept the stated agreement
Name*

First NameLast Name
Email*
example@ccsu.edu
Date*

MonthDayYear
Signature*

Clear
Should be Empty:

Payroll Deduction Agreement and Authorization to make a gift to the CCSU Foundation, Inc.