JCU Employee Payroll Deduction Giving Form

Employee ID (Banner ID) #

First Name

Last Name

JCU Email Address

JCU Phone Number

Please Direct My Gift To:

The Carroll Fund

Other

If Other Please Specify

Payroll Deduction Options: Forms must be submitted by the 15th of the month to start a deduction the following month. You may choose to end your payroll deduction at any time by sending written notification to the Development Office. *

I would like to set up a multi-payment contribution to be deducted from my pay in equal installments. ($5 minimum per deduction, 12 month maximum).

I would like to make a one-time payroll deduction contribution ($5 minimum)

Total Amount of Gift (ie $5 per pay x 26 pays = $130

I am Paid:

Bi-weekly (26 per year)

Monthly (12 per year)

Your request will be forwarded to the Department of Advancement Services and the Payroll Department.
For questions regarding this procedure please contact Bridgette Chicone at bchicone@jcu.edu or at ext 4338.