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Donation Deduction Authorization Form

Donation Deduction Authorization Form
Southwestern Michigan College Foundation

Personal Information
One-Time Payroll Deduction
$
Enter the amount of one time gift in the space provided above.
Pay Period Donation Allocations
$ per pay period
See Michelle Kite, Controller for gift details and engraving specifications (x1302). Immediate information and order form can be found at swmich.edu/alumni.
$ per pay period
If you would like your donation to go to a specific use, please select from the list provided
$ per pay period
$ per pay period
$ per pay period
$ per pay period
Total Payroll Deduction
$ {alumni_plaza_gift_sap}+{nursing_renovations}+{smc_student_worker_program}+{nursing_endowment}+{unrestricted_foundation_fund}+{endowment_of_your_choice} per pay period
The above amount is read only and has been automatically calculated based on the entries you made in the Pay Period Donation Allocations section of this form. To change the amount of your pay period deduction, please adjust the dollar amounts entered above.
Authorization

The above deduction authorization will begin and remain in effect within SMC fiscal year which falls within the effective date you indicate below. Southwestern Michigan College's fiscal year runs from July 1 to June 30. Any change to the deduction can be made during the fiscal year by contacting Payroll. I understand that one payroll period is required for a change to take effect.

This authorization will expire at the end of the SMC's fiscal year. If you want to continue your donation beyond that date, please consider completing and submitting this form again.

By submitting this form, I hereby authorize Southwestern Michigan College to deduct the following amount from each of my paychecks for the remainder of the current fiscal year. These amounts are then to be donated to the Southwestern Michigan College Foundation as allocated above.