Employee Voluntary Tuition Deduction Form

Employee Voluntary Payroll Deduction Authorization for School Fees

Please don't fill out this input box.

Student's name*

Deduction Type*

Per pay amount

Percentage

This deduction should begin

with the:*

1st

2nd

...of this month:*

* Request must be submitted within 10 days of the pay period selected for the deduction to begin.

If I already authorized deductions of this type on my pay record, this change:

Is in addition to the previous payment authorizations(s)

Cancels and replaces my previous payment authorization(s)

Employee Signature

Full name*

Today's Date*