Staff Voluntary Payroll Deduction

Staff Voluntary Payroll Deduction
Employee Name*

First NameLast Name
Building Employed*

Central OfficeJohnson ElementaryLexington ElementaryScottsburg Elementary SchoolScottsburg Middle SchoolScottsburg High SchoolVienna-Finley Elementary School
Email*
example@example.com

Funds To Be Deducted*

Rows	Student (or Staff)Name	School	How much per pay?	Funds Used For?(lunch, preschool, repairs, etc.)
1.
2.
3.
4.