RPCC Foundation Payroll Deduction Authorization Form

Payroll Deduction Form
Please complete the Payroll Deduction Authorization Form.
Name
Employee ID
Department
Email
example@example.com
Phone
Format: (000) 000-0000.
Payroll Deduction Details
I authorize River Parishes Community College (RPCC) to deduct the following amount from my payroll check each pay period as a charitable contribution to the RPCC Foundation:

Other
Ongoing Payroll Deductions
The ongoing payroll deductions will begin on the following date.

MonthDayYear
Date
One-Time Payroll Deduction
The single payroll deduction will be drafted on the following date.

MonthDayYear
Date
Designation of Funds
Please direct my gift to the following fund(s).

Other
Authorization and Signature
I understand that this deduction is voluntary and will continue as indicated above until I notify the RPCC Human Resources Office in writing to adjust or discontinue my contribution. I also understand that my payroll deduction contributions may be tax-deductible, and I will receive an annual summary for my records.
Date

MonthDayYear
Date
Signature

Clear
River Parishes Community College Foundation is a 501(c)(3) nonprofit organization. Your donation is tax-deductible to the extent allowed by law.
Should be Empty:

Payroll Deduction Form