GAGE Check-Off Authorization

GAGE Check-off Authorization
The Georgetown Alliance of Graduate Employees (GAGE) is a democratic organization built on the idea that we, as graduate workers at Georgetown University, bargain for a better contract for all our members, together. We seek to empower graduate employees and ensure that we have an equal partnership in decisions that shape our future and the future of Georgetown University.

STATUS: Agency Fee Payer
Name*
Georgetown University Net ID (e.g. abc123)*
Degree Program
Degree Department
Job Title and Department
Check-off Authorization
I hereby request and voluntarily authorize my Employer, and my Employer's successors, to deduct from my earnings and to pay over to the Union, and its successors, my membership dues or agency fee. This authorization is applicable only when I am employed in a position in the bargaining unit defined in Section 2 of the April 2, 2018 Agreement between the Union and the Employer. This authorization shall remain in effect and shall be irrevocable unless I revoke it by notifying the Union and the Employer's Office of Student Employment in writing. This authorization shall be automatically renewed as an irrevocable check-off when I am employed in a position in the bargaining unit unless I revoke it, regardless of my membership in the Union.*

Clear
Signature*
Date

MonthDayYear
Date
IRS Disclaimer: Payments to the Union are not deductible as charitable donations for federal income tax purposes. However, they may be tax deductible as ordinary and necessary business expenses.
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GAGE Check-off Authorization

Check-off Authorization