Payroll Deduction Sign Up

GovState ID Number*

GovState Email Address*

First Name*

Last Name*

Birthdate*

Number of Areas to Support:

You may select up to four areas to support.

Area of Support 1:

Gift Amount

Search Fund

When an active fund above is selected, the internal code will be displayed here.

Area of Support 2:

Gift Amount

Search Fund

When an active fund above is selected, the internal code will be displayed here.

Area of Support 3:

Gift Amount

Search Fund

When an active fund above is selected, the internal code will be displayed here.

Area of Support 4:

Gift Amount

Search Fund

When an active fund above is selected, the internal code will be displayed here.

Agreement

*By selecting "Yes" below, I understand the amount indicated below will continue to be automatically deducted from each paycheck. If I desire to make any changes, I will notify the The GovState Foundation (engage@govst.edu) in writing or by email.

Yes

Total Deduction Amount Per Paycheck:

Payroll Deduction Sign Up

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