Payroll Deduction Form

OREGON STATE UNIVERSITY | Payroll Deduction Authorization

THANK YOU for selecting the payroll deduction option to support Oregon State programs. Participating employees from the university and the OSU Foundation may use this electronic form. Please submit it by the fifth day of the month when you wish to begin deductions from your payroll check. If your form is received on the sixth day of the month or later, your deductions will begin the following month.

President’s Circle: Individuals whose annual gifts to any area(s) at Oregon State University total $1,000 ($84 per paycheck) or more are recognized with membership in the OSU President's Circle.

Your Information

Oregon State University ID#
Required for OSU Employees
First Name:
required
Last Name:
required
Primary Email:
Campus Department/Unit
required
Campus Phone #
required
City:
required
State:
required
Zip:
required

Gift Information

I would like my tax-deductible gift to support the following program(s): (Please be specific)

Gift Duration

Total Monthly Payment *
Number of Installments
Month to Begin
Please omit my name from the honor roll of donors

* ($5 minimum)

Signature & Confirmation

As provided in ORS 292.014, I hereby authorize the deduction from my paycheck each period for the amount designated above.

Please type your full-name to confirm an electronic signature
Please enter today's date (mm/dd/yyyy)