College of Business Dean’s Leadership Circle

UTA COB DLC Payroll Deduction Request Form
UTA Payroll Deduction Request Form
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.
Monthly contribution amount(s)
Monthly contribution amount(s)







$


Preferred Email: Required Field




Check all that apply:
Check all that apply:




$
(Your deduction will end at this amount. Leave blank if you wish your deduction to continue until you notify us to stop.)


Change(s) in gift deduction amount or recipient fund/dept.
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?
$
$
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: