Payroll Deduction Form

Payroll Deduction Form

Payroll Deduction Authorization for Gifts to the University of Illinois

 

 

I wish to make a gift of $ per check (minimum $5/mo.)to .

 

Full Name 

Email 

 

By submitting this form electronically and typing my full name, I authorize a deduction in the amount shown above to be withheld from my pay in accordance with the State Salary and Annuity Withholding Act to be remitted to the University of Illinois Foundation (payee code no. 40). 

Please select 

 

My gift deductions can continue for: (minimum of 3 months)

12 months   36 months   until I request termination

months or terminate on 
 

 

This authorization:

INITIATES my automatic gift support through payroll deduction

CHANGES the amount of my gift from that presently being withheld

TERMINATES my payroll deduction gift support

is for JOINT CREDIT with spouse or life partner

 

Full Name 

Home Address 

City  State   Zip 

UIN 

 

My University of Illinois Unit:

UIUC   UIC   UIS   OTHER 

Department 

Office Address 

University Unit 

Date 

 

 

Questions? Call (312)996-4470



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