/ Giving/ Employee Giving - Payroll Deduction Form

Employee Giving - Payroll Deduction Form

For questions, contact Lauren Creany, Director of Donor Engagement. Email: lcreany@lclark.edu Phone: x7963

All fields marked with asterisk (*) are required.

required text field

Name*

required text field

LC ID*

required e-mail address field

LC Email Address*

required text field

Campus Department*

required text field

MSC*

required text field

Campus Phone*

horizontal_line field

header field

Payroll Deduction

required radio button field

Is this a new deduction or update to a current deduction?*

New deduction

Update to current deduction

text field

Lewis & Clark Fund Designation

text field

Amount per Paycheck

date field

Start Date

Deductions are ongoing unless updated or canceled by employee

horizontal_line field

header field

Required Authorization

required text field

Electronic Signature*

Type full name

required checkbox field

Verify and Authorize*

By checking this box and signing my name above, I authorize Lewis & Clark College to withhold the amounts indicated above from each paycheck. I understand that deductions made to Lewis & Clark are ongoing without end unless changed by me.

Link (required)