Payroll Deduction

Name*

First Last

Department*

Monthly Pledge Amount*

Campus Phone Extension*

If you do not have a campus phone, please enter your home or mobile number.

Email*

Indicate to which programs you would like to designate your pledge:*

Other Program

* One-time gifts also can be paid by cash, check, Visa or MasterCard.

* Pledges may be paid in one lump sum or multiple payments as well as by payroll deduction.

Please contact Nakeysha Hamilton (373.5316 or nhamilton@ndc.edu) if you have any questions.

With my electronic signature below, I hereby authorize Notre Dame College to deduct the previously specified amount from my paycheck.

* Payroll deductions will be made continuously unless you request they be discontinued.

Electronic Signature (type full name)*

Date*

Forms submitted after the 20th of each month will not go into effect until the next pay period.

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Comments

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Employee Giving Form