Peru State College Foundation Payroll Deduction Form

The Peru State College Foundation invites College employees to participate in the payroll deduction program. This is an opportunity for employees to make a financial investment in Peru State. As the Foundation seeks funding from alumni and friends, employee participation and support demonstrates Peru State College employees’ continued commitment to the mission and values of the institution.

To participate, please complete the below form. An email copy will be sent to the PSC Foundation,
to the Peru State College Human Resources Office and you will receive a copy for your records.

Please note payroll deductions must be received by the 20th of the month for the deduction to be in the current payroll. Also your payroll deduction will end the next JULY 31st following your submission. You will be notified in advance to renew your gift! Thank you!

Name Name * First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email *
How much would you like to give each month? *
The date your payroll deduction will end. The date your payroll deduction will end. / MM / DD YYYY
Other instructions/requests related to the gift or area of gift designation:
Please draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.