Student Employee Payroll Deduction - Northwood University Forms

Your Information

Your Name *

First Last

Student ID *

Department of Employment *

Campus Email *

Phone *

Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gift Designation Information

Please designate my gift to: *

The Northwood Fund (Greatest Needs)
General Endowment Fund

Payroll Deduction Information

Make Your Gift Over 12 Months:

Annual Impact	Per Paycheck
Annual Impact: $300	Per Paycheck: $12.50
Annual Impact: $240	Per Paycheck: $10
Annual Impact: $120	Per Paycheck: $5
Annual Impact: $100	Per Paycheck: $3.85
Annual Impact: $65	Per Paycheck: $2.50

Contribution (Per Pay Period)

Date of First Payroll Deduction *

Duration *

Until further notice
One-time gift
Until a specific date
Until a specific amount is reached

Deduction End Date *

Deduction Goal Amount *

New or Additional Deduction? *

This deduction will replace and supersede previous payroll deductions
This deduction will be added to current payroll deductions

Please note that it may take up to two pay periods before your contribution is reflected in your paycheck.

Official tax receipts will be issued twice per year.

Need to make your gift via credit card or check?

You can also print and fill the paper form. Please mail any printed and filled forms to:

Northwood University Business Office/Advancement

4000 Whiting Drive

Midland, MI 48640

Checks should be made payable to Northwood University

Statement of Consent *

I understand and agree that by filling out this form, I am giving consent to Northwood University Payroll to deduct the above amount(s) from my check

Your Full Name *

By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature.

Phone

This field is for validation purposes and should be left unchanged.