Payroll Deduction Form

Legal First Name

Preferred First Name

Last Name

Austin College Email Address

Colleague ID

Birthdate

Please allow 10 business days for processing before deduction begins.
Please note: the first deduction will occur on the next pay date after the 10 business days.

Start Date for Deduction

End Date for Deduction (leave blank for ongoing)

Confirmation of Ongoing Deduction

Yes

Donation Amount (per month)

Where do you want your gift designated?

Austin College Annual Fund

Scholarships

Other

Other Designation

I authorize the amount stated above to be deducted from my pay for the designated amount of time or until I request cancellation.

I agree