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RSC Employee Payroll Deduction

AUTHORIZATION FOR PAYROLL DEDUCTION

I wish to contribute to the Rose State College Foundation through Payroll Deduction. I understand that the funds donated will be used to continue academic excellence at Rose State College, particularly student scholarships and academic enhancements.

The RSC Foundation is a registered 501(c)3 organization. All gifts are tax-deductible.

I request that

Amount

per month be payroll deducted from my salary as a contribution to the RSC Foundation.

I request that my donation be used for: (please select one fund)

Untitled

Unrestricted

General Scholarship Fund

Other

Employee Name

First Last

Home Mailing Address

Street Address City State / Province / Region ZIP / Postal Code

RSC Department

RSC Extension

Signature

Date

Withholding will continue until further notice.

For Payroll Office Use Only:

Date Started

Date Ended

“All hard copies should be returned to the Foundation Office in the Community Learning Center Room 100 or email the completed form to [email protected]”

RSC Employee Payroll Deduction

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