Payroll Deduction Form

Date

Employee Information

Name

First Last

Richland ID Number

Personal Email

Phone Number

Mailing Address*

Donation Information

Per Pay Period Amount*

Designation*

Please indicate your designation(s) below. If you select more than one designation, please indicate designation and amount it in the special instructions below. Amount(s) per designation must add up to the total per pay period amount.

The Greatest Needs of the College
Student Assistance Fund
Investing in the Future Scholarship Fund
Project Read Plus
The Pantry at Richland
MCLETC Trick or Treat Fund
The United Way
Other- A Richland Program or Fund of your Choice

If other, specify scholarship, program or fund.

Number of pay periods*

Please select the number of pay periods to divide the gift. You can choose a one-time deduction from a single paycheck, or divide it up to 26 pay periods.

One-time
26 pay periods
24 pay periods (faculty)
Roll over until I tell you otherwise

Special Instructions

If you select more than one designation, please indicate the designation and amount. Amount(s) per designation must add up to the total per pay period amount. The amounts you allocate to each designation should be in whole-dollar increments.

Authorization*

By submitting this form, I authorize the action above in the amount and frequency indicated. I understand that if I selected a recurring donation, the gift will continue at the amount and frequency indicated until I request a change in writing to either the Richland Foundation or the Richland payroll department.

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Payroll Deduction Form

Payroll Deduction Form 2024 Campaign

Employee Information

Donation Information