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Employee Gift Payroll Deduction
In addition to all you do as an employee of the college, making a gift through a payroll deduction shows your
strong commitment to the continued excellence of Harvey Mudd College. Thank you for your support.
Please fill in the following information and return it to the Office of College Advancement (Kingston Hall,
Second Floor Director of Advancement Services). We will forward the original to the Pendleton Business
Office and retain a copy for our files. If at any time you wish to modify or discontinue your payroll deduction
gift, please contact the College Advancement Office at ext. 73469
Check One: Faculty Staff
Name: ____________________________________________________________________________________
(Please Print)
Social Security Number: _____ - ____ - _____
Department: _______________________________________________________________________________
Campus Address: ____________________________________________________________________________
Campus Phone: _____________________________________________________________________________
Indicate your pay schedule: Monthly Biweekly (Your gift will be deducted form the first paycheck each month)
Please deduct $_____________________ from each paycheck as my gift for Harvey Mudd College.
Annual Mudd Fundd Gift Designation:
Unrestricted (Payroll code gift-5)
Scholarships (Payroll code gift-5)
Campus Support (Payroll code gift-5)
Faculty Support (Payroll code gift-5)
Other Initiatives:
Special Designation (Payroll code gift-5):
___________________________________________________________(Identify special designation area)
This deduction should continue:
Until further notice Until _________________
Discontinue Current Deduction Effective _______________
Signature: ______________________________________________________ Date: ____________________
Payroll Deduction Form
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