UCA Faculty and Staff Payroll Deduction

Your Information

First Name: Required Field

Last Name: Required Field

I am: (check all that apply) Required Field

Department in which you are employed: Required Field

UCA ID:

Email:

Address:

City:

State:

Zip:

Work Phone Required Field

Check if your spouse is also a UCA employee:

First Name:

Last Name:

Designations

Please designate which fund you would like your payroll deduction to go to. The complete list of funds can be found here. You may choose multiple funds.

Annual Fund (Area of Greatest Need)

Student Emergency Fund

Fund(s) of your choice (type in box):

Payroll Deduction Authorization

I hereby authorize UCA Human Resources to deduct the following amount from my salary.
Please indicate the amount you want deducted monthly and per pay period.

A minimum of 3 months is required for payroll deduction. You can make a gift by check, cash or card if it is less than 3 months.

Amount to be deducted monthly: Required Field

Amount to be deducted per pay period: Required Field

Effective the following dates:

Beginning pay period

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Until Further Notice

Ending Pay Period

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Comments:

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