Download Employee Payroll Deduction Authorization Form

Employee Payroll Deduction Authorization Form
Yes, I would like to make a payroll deduction donation
ANNUAL FUND GIFT
Amount per pay period: $
MY GIFT WILL SUPPORT:
MY GIFT WILL SUPPORT:
EMP. ID#:
Faculty
Administrative Faculty
Gift(s) Total per pay period:
First Name
Last Name
College/Dept.:
Campus Mail Stop:
My e-mail address is:
Campus Phone: (702)
City
Home Address:
Phone: (
Amount per pay period: $
Name of College, School, Fund or Department
Classified
Dr./Mr./Mrs./Ms.
Amount per pay period: $
Name of College, School, Fund or Department
State
Zip
Spouse/Partner:
)
I hereby authorize payroll to make the above listed payroll deductions from my salaries and wages for philanthropic gifts of my choice identified
on this form. This authorization will remain in effect until cancelled in writing by myself or by payroll.
*This payroll deduction form replaces any current UNLV designated payroll giving agreements in place for the named employee above.
I certify that I am an employee of the University of Nevada, Las Vegas and understand that termination of employment will cancel all
deductions made under this authorization.
Signed:
Date:
Did you know?
Every year, 1 in 5 faculty
and staff make a gift in
support of UNLV students.
Support UNLV through Employee Payroll Deduction
Annual Giving
KUNV Radio
Athletics: Rebel Athletic Fund
Libraries
Barrick Museum
Marriage & Family Therapy
Center for Autism
Nursing Skills Lab
Classified Staff Dependent’s Scholarship
Oral History Project
fund (like Annual giving) to support
Classified Staff Development Fund
Renewable Energy Program
② Share your name, contact information, and
Debate League
Sgt. Clint Ferin Dental Clinic
For the past 57 years faculty and staff have
understood firsthand the value of investing in UNLV
and our mission. Whatever your position may be,
you play an important role in educating the brightest
young minds and strengthening the cultural and
intellectual fabric of our community.
How to Make Your Gift:
① Choose your favorite department, division, or
signature to complete the form
General Scholarship Fund
Science Bowl
mail to the Foundations Building
(Mail Stop 1006)
Graduate Assistantships
Student Affairs
④ Breathe deeply and smile as the gratitude from
Graduate College
Thomas & Mack Legal Clinic
Healthy Homes Initiative
UNLV Preschool
The Huntridge Teen Dental Clinic
UNLV Cares Food Pantry
③ Drop the form off in person or send it by
countless others washes over you
⑤ Your payroll deduction gift will begin within
one to two payroll cycles
Institute for Children's Research and Policy Veteran Student Services
To make a one-time gift, visit us at www.unlv.edu/foundation/give-online