Payroll Deduction Form

EMPLOYEE INFORMATION

Name:
Email:
Department:
Address:

City:

State:

Zip:

Phone:

Primary Affiliation: Staff Faculty Adjunct Faculty

Consider a pledge over the entire year to increase the impact of your gift. Even a small amount each pay period can have a huge impact on the life of a student!

$38.47 per pay for one year = $1,000

(President’s Club Membership)

$25 per pay for one year = $650

$15 per pay for one year = $390

$10 per pay for one year = $260

GIVING OPTIONS

I would like to make a one-time gift of $

I would like to pledge $ for number of pay period.

GIFT DESIGNATION

Student Emergency Assistance Fund (EMFF)

Employee Scholarship (SB)

Student Scholarship Fund(SSFD)

Frontliners Scholarship(FLSF)

Lesia Mahon Memorial Scholarship(LMMS)

Center for Teaching and Learning

Other:

PAYMENT METHOD

I authorize payment through payroll deduction as specified.

ADDITIONAL INFORMATION:

I would like to make this gift anonymously. Please issue me a tax receipt but withhold my name from annual donor honor roll.

I am interested in more information on creating a scholarship to benefit Walsh students.

I am interested in more information about including Walsh in my estate plan.

Thank you for making a difference with your support for our students!

Signature:

Date:

Questions? Please contact: annual giving, ext. x1241 or payroll, ext. x1380

SUBMIT

Walsh is accredited by the Higher Learning Commission ( www.hlcommission.org; phone: 312-263-0456). Specific degree programs are accredited by the Accreditation Council for Business Schools and Program (ACBSP, www.acbsp.org).
Administrative Offices are located at 3838 Livernois Rd, Troy, MI 48083. Additional locations in Michigan: Novi, Clinton Township, and Port Huron.