UTA Payroll Deduction Request
UTA Payroll Deduction Request
I want to contribute monthly through the Payroll Deduction Program. In doing so, I am recognized as a member of the Nedderman Society - faculty and staff who give back to UTA.
I want to contribute monthly through the Payroll Deduction Program. In doing so, I am recognized as a member of the Nedderman Society - faculty and staff who give back to UTA.
$5 mo. ($60/yr)
$10 mo. ($120/yr)
$25 mo. ($300/yr)
$50 mo. ($600/yr)
$84 mo. ($1008/yr)*
Other Monthly Amount
$
Dollars
.
Cents
Name
Name
*
First
Last
Email
*
UTA Employee ID
*
UTA Box
Extension
Home Phone
Home Phone
*
-
###
-
###
####
Check all that apply:
Check all that apply:
Faculty
Staff
Alumni
Current UT Arlington Student
Parent of Current Student
Recipient Fund or Department
Cost Center (if known)
A change in gift deduction amount or recipient fund/dept. requires completion of this section.
Is this an addition to, or decrease in, a payroll deduction already in effect?
Is this an addition to, or decrease in, a payroll deduction already in effect?
Yes
No
Current monthly donation level:
$
Dollars
.
Cents
I wish to change to (monthly)
$
Dollars
.
Cents
I wish to keep my donation at the current level but change to a different recipient fund/dept:
I wish to keep my donation at the current level but change to a different recipient fund/dept:
Yes
No
New recipient fund/dept/purpose: