Print Logo
  • Giving Banner - dream

    Give to MSU

  • Giving Banner - gift

    Give to MSU

  • Giving Banner - opp

    Give to MSU

MSU Home :: Online Payroll Deduction Form

Payroll Deduction Form

Please fill out the form below to set up your payroll deduction.

Name:

Street:
 

Street2:
 

City:
 

State:

Zip:
 

Phone Number:

Campus Email:

Last 4 digits of your Social Security Number (for verification purposes, form will not be processed without it):


Click here to see a list of fund areas.

Fund Area:
 

Fund Area 2:

Fund Area 3:

If you choose "other", please type the designation here:
 

Payroll deduction amount per pay period ($2.50 minimum):
$  


Please choose ONLY ONE of the following:

I authorize the MSU Foundation to deduct the above amount each pay period for this period of time:

Beginning Date
Ending Date
 

OR

I authorize the MSU Foundation to deduct the above amount each pay period until I provide instructions to stop (automatic renewal):

 

Please Initial:

 

© Copyright 2014 Morehead State University - 150 University Blvd. Morehead, KY 40351 • 1.800.585.6781
MSU is an affirmative action, equal opportunity, educational institution.