Payroll deduction form

Full legal name

Home Address

City, State, Zip Code

Phone number

Personal Email

Payroll Deduct Amount

Per Pay Period, Effective:

Per Pay Period, Effective Until:

Employee ID Number

Employment Type

9 month 12 month

Deduction

New Payroll Deduction Replacing Existing Deduction

Gift Designation

Wherever it is needed most My preference

My preference (list up to 3 areas)

NOTE:

For tax purposes, the official date of your payroll deduction gift to the University of Wisconsin-La Crosse Foundation is the date the gift is received by the Foundation from the UW System Shared Services, not the date payroll is processed.

UWL HR has advised of changes to payroll that will take place in July 2021 as part of the Single Payroll project. These changes may affect your monthly deductions including to the Foundation. Please contact UWL HR directly with questions regarding payroll changes.

*Year-end giving statement will be mailed to your home address.

By submitting this form you are verifying that all information is correct.

A page within UWL Alumni & Friends Foundation

NOTE: