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

  • To enroll in payroll deduction

  • I,      , hereby request Central Connecticut State University to deduct from my biweekly salary a total of $   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.

  • How would you like your gift to benefit CCSU?

  • I would like $ of my deduction to benefit 

  • I would like $ of my deduction to benefit 

  • I would like $ of my deduction to benefit 

  • I would like $ of my deduction to benefit 

  • I would like $ of my deduction to benefit 

  • I would like $ of my deduction to benefit 

  • CCSU Alumni Pavilion Brick

    If you are choosing to use your payroll deduction to benefit the "CCSU Alumni Pavilion Brick," set the deduction amount to the amount below based on when you are starting the deduction.

    Commitment Date

    Deduction Amount

    By February 19

    $111

    February 20 – March 5

    $125

    March 6 – 19

    $143

    March 20 – April 2

    $167

    April 3 - 16

    $200

    April 17 – 30

    $250

    May 1 – 14

    $333

    May 15 – May 28

    $500

    May 29 – June 11

    $1000

    All payroll deposits for bricks will end 6/12/2026

  • 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.

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