Campus Recreation Payroll Deduction Cancellation

Campus Recreation Payroll Deduction Cancellation

Please complete this form to cancel your payroll deduction membership at the CRC. Please note the below policy for when your deductions are turned off based on your paygroup:

For monthly/academic employees paid once per month, you must complete this form by the end of the 4th day of the month in order not to be charged for the month.
For bi-weekly employees paid twice per month, you must complete this form by the end of the 2nd day of the 2-week pay period in order not to be charged for that pay period.

Legal First Name*

Legal Last Name*

GTID Number*

Employee ID Number*

You can find this in your Employee Self Service in OneUSG.

Email Address*

Paygroup*

Select or enter value

Payroll Deduction Action*

Select or enter value

Cancellation Agreement*

By typing your full name below, you are agreeing that you are a benefits-eligible Georgia Tech employee and authorize Georgia Tech to change withholdings of your single membership, membership with family (spouse/domestic partner), membership with plus one, or membership with family plus one payment from your academic/monthly/bi-weekly paycheck. You also understand cancellations must be made (a) Before the end of the day (11:59 p.m.) the fourth day of the month for Academic/Monthly employees to avoid a full month charge or (b) By the end of the day (11:59 p.m.) on the second day of the Bi-Weekly pay period end (see payroll processing calendar for Bi-Weekly employees).

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