Employee Payroll Deduction Form

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Employee Payroll Deduction Form

Use the form below to make a gift via payroll deduction.

Payroll deductions will be established as a recurring gift without an end date unless otherwise specified. If you wish to contribute through a method not specified on this form, please contact DUA's Office of Advancement Services.

To contribute to Athletics via payroll deduction, please visit the KSU Athletics Giving Page or contact The Owls Fund.

Contact Information

Name*

First Name

Last Name

Department*

Email*

Phone*

KSU ID# (e.g., 000123456)*

I wish to*

Establish giving via payroll deduction for the first time Inquire about my existing payroll deduction(s) Modify my existing payroll deduction(s) Create payroll deduction(s) in addition to my existing payroll deduction(s) Discontinue my existing payroll deduction(s)

I have a question about or want to discontinue my existing payroll deduction(s):*

Payroll Information

Payroll Status*

Monthly Biweekly Academic (8 mo) Academic (10 mo)

Please deduct $ per pay period until otherwise notified* $

Employee Payroll Deduction Form

Contact Information

Payroll Information

Gift Information