Payroll Deduction Form

Date*

Employee Information

Name*

First Last

Richland ID Number*

Email*

Phone Number

Donation Information

Per Pay Period Amount*

Designation*

Please indicate your designation(s) below. If you select more than one designation, please indicate designation and amount it in the special instructions below. Amount(s) per designation must add up to the total per pay period amount. The amounts you allocate to each designation should be in whole-dollar increments.

Greatest Needs of the College
Student Assistance Fund
Investing in the Future Scholarship
Project Read Plus
Pantry at Richland
United Way Impact Fund
Other

If other, specify scholarship, program or fund.

Number of pay periods*

Please select the number of pay periods to divide the gift. You can choose a one-time deduction from a single paycheck, or divide it up to 26 pay periods.

One-time
26 pay periods
24 pay periods (faculty)
Roll over until I tell you otherwise

Special Instructions

Share my Gift!

Please share my gift to encourage giving throughout the campaign!

Authorization*

By submitting this form, I authorize the action above in the amount and frequency indicated. I understand that if I selected a recurring donation, the gift will continue at the amount and frequency indicated until I request a change in writing to either the Richland Foundation or the Richland payroll department.

CAPTCHA