Employee Voluntary Payroll Deduction Authorization for School Fees If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Student First Name * Student Last Name * Deduction Type * Per Pay Pay AmountPercentage Per Pay Amount (2X Month) * Stop when this dollar amount is reached Percentage * Stop when this dollar amount is reached: This deduction should begin with the: * 1st2nd In 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 Signiture Type Full Name * Date *
