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Foundation

College Employee Payroll Deduction Form


Complete and submit form:

First Name:(*)
First Name
Last Name:(*)
Last Name
Employee ID#:(*)
Employee ID#
Email:(*)
E mail Address
Street Address (*):
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State (*):
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Zip Code (*):
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City (*):
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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.(*)
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I would like my donation directed toward:(*)
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Please specify the scholarship you wish to support (optional).
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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 web site.
If yes, my name should appear in the publicity as:
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*denotes required

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.