Payroll Deduct Form – Arts Society - Missouri Western State University

Missouri Western Arts Society
Faculty and Staff Payroll Deduction
Authorization Form
Please complete and return this payroll deduction form to
MWSU Foundation, Attn: Susan Leslie, Spratt Hall 110
Name _____________________________________________ G#________________________
Department ______________________________ Campus Phone________________________
Amount Pledged: $___________
___ Art Society Enrollment Form already on file
___ Art Society Enrollment Form Attached
___ Please send an Art Society Enrollment Form
I, _________________________, authorize the Payroll Department of Missouri Western State
University to deduct:
A one time payment of $ __________ from my next paycheck annually until I
request it stopped.
$_________ per Pay Period until I request it stopped
I am an Exempt Employee
10 pay periods (August through May only each year)
12 pay periods
I am a Non-Exempt Employee
20 pay periods (2x each month August through May only each year)
24 pay periods (2x each month)
Signature _________________________________________ Date _______________________