Payroll Deduction Form

Thank you for supporting Adelphi with your gift via payroll deduction! Please submit this form to the Office of University Advancement at least 10 days before your first scheduled deduction. Questions? Please contact advservices@adelphi.edu.

Employee Contact Information

Employee Name*

Employee ID

Email Address*

Campus Phone Number

Department

Street Address

City

State

Zip

Gift Information

Please select one of the payment options below. Charitable gifts are deducted across 26 paychecks per year.

Option 1: I would like to set up an ongoing recurring gift

Please deduct the following amount from each payroll until further notice:

Beginning with the first pay period in the month of:

Select or enter value

Option 2: I would like to contribute a set amount and divide my payments equally over time

Please deduct the following amount from each payroll:

Beginning with the first pay period in the month of:

Select

Until my payments reach a total contribution of:

Gift Designation*

Select

Please enter your gift designation below:

Signature*

In writing your name below you authorize the Payroll Deduction Department of Adelphi University to deduct the amounts above from your payroll check:

Send me a copy of my responses

Privacy Notice|Report Abuse