Payroll Deduction Gift Form » University of Colorado Foundation

Payroll Deduction Gift Form

Personal Information
Employee Name
Spouse Name
ID or SSN
Street Address
City
State
Zip Code
Home Phone
Cell Phone
Employment Information
Please indicate if you are employed by the CU Foundation or the University.
CU Foundation CU Faculty/Staff
If CU Faculty/Staff
Title
Department
Campus Box
Business Phone
Business E-mail(valid e-mail required)
CU Graduate?
Yes No
If no, name of Alma Mater

Deduction Information

ADD
Amount
Allocation # (if unknown, enter name or description)
Effective Date
Ending Date
OR
Until Further Notice
CHANGE
Current Amount
New Amount
Current Allocation (number, name, or description)
New Allocation (number, name, or description)
Effective Date
Ending Date
OR
Until further notice
STOP
Cancel current
deduction(s) effective

Authorization

I herein authorize this deduction from my payroll as outlined above.

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