This form may be used to set up a new deduction or change a current deduction.

• If you are changing your deduction, please list the new total monthly amount you would like to have deducted from your paycheck.
• For your deduction to be split between two separate funds, please include the fund names and amounts in the Comments section.
• The deduction will be ongoing until you notify the Foundation to stop or make a change.
• Changes after the 10th of each month will be effective the next month.
• Please list whole numbers only.