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Name

Contact Information

Home Address

What would you like to do?

What type of modification would you like to do?

Payroll Period

My deduction is to:

Would you like to add additional designations?

My additional deduction is to:

My additional deduction #2 is to:

My additional deduction #3 is to:

Tribute Type

Is this deduction for Day of Giving?

Donor Wall Information

Authorization Agreement

By agreeing to the following: I understand that this form authorizes my payroll department to withhold from my salary and/or wages for the designated amount per paycheck and that the designated amount will be remitted to the WVU Foundation the month following the deduction. I further understand that this arrangement will continue until I notify WVU Foundation in writing to terminate it. This form overrides existing payroll deductions to the WVU Foundation. All fund deductions must be indicated on this form and may not be changed retroactively.