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College Employee Payroll Deduction Enrollment Form

Complete and submit form:

First Name:(*)
First Name
Last Name:(*)
Last Name
Employee ID#:(*)
Employee ID#
E mail Address
Street Address:(*)
Street Address
Zip Code:(*)
Zip Code

Amount of deduction per pay period: (Example: If you authorize a $10 deduction per pay period, you will contribute $260 in a yearly period.)
Amount of Deduction per pay period:(*)
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I would like my donation directed toward:(*)
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If Campus Fund is selected, please specify where you would like your funds directed.
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Special Instructions: May we include your name in the publicity of our donors? This authorization includes, but is not limited to, publications and our donor listing on the Foundation page of the Minnesota West website.
Include my name:(*)
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If yes, my name should appear in publicity as:
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Thank you for supporting the Minnesota West Foundation! This enrollment form will be forwarded to the Minnesota West Foundation for processing. Implementation of this deduction will take place approximately 4 weeks after enrollment.

*denotes required