Faculty and Staff Payroll Deduction Commitment Form

Personal Information

Siena ID:

Title (Mr., Ms., Dr., etc.):

First Name: Required Field

Last Name: Required Field

Suffix (Jr., Sr., etc.):

Primary Email: Required Field

Email

Business Phone Number:

Department: Required Field

Position:

Pledge Information

New/Existing Deduction: Required Field

Pay Period Schedule: Required Field

Amount per pay period: Required Field

$

Choose your area of Support Required Field

Choose your area of Support Annual Fund | President's Discretionary Fund
Annual Fund | Academic Programs
Annual Fund | Facilities and Grounds
Annual Fund | Financial Aid
Other

If you selected other, please specify where you would like to allocate your gift:

Length of Deduction: Required Field

# of Years/Pay Periods:

Comments:

Cancellation Policy

Cancellation Policy: If deduction period is indicated as indefinite, you recognize that this payroll deduction will stay in effect until such a time that you change it via formal notification to Human Resources and Development. Click here to cancel your payroll deduction.

I agree

Confirmation

You are about to submit your payroll deduction form over our secure server. Please check your information carefully for accuracy, and then click "Submit."

Faculty and Staff Payroll Deduction Commitment Form

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