Payroll Deduction Form

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

SAU ID Number(Required)

Campus PO Box(Required)

Campus Phone(Required)

This pledge is(Required)

New

Altering an existing pledge

Please deduct the following amount each pay period Required Field(Required)

$10

$25

$50

$100

Other Amount See Below

Other Amount

I wish for my gift to support the following programs Required Field(Required)

Student Enrichment

Faculty and Staff Support

Campus Improvements

Academic Program Opportunities

Athletics Enhancements

Greatest Need

Gift Designation / Specifications

Please select one of the options below Required Field(Required)

This authorization begins now and will be discontinued after a specified date. (see next step)

This authorization is in place until further notice

Date after which to end payroll deduction.

MM slash DD slash YYYY

SAU Office of Development

100 E University 9340, Magnolia, AR 71753 | Telephone: (870) 235-4287