Give
Menu
Search Content:
UNM School of Medicine - PAYROLL DEDUCTION AUTHORIZATION
UNM School of Medicine - PAYROLL DEDUCTION AUTHORIZATION
UNM School of Medicine - PAYROLL DEDUCTION AUTHORIZATION
Name
Home Address
City, State & Zip
Banner ID
Preferred Email:
Payroll Status
Please Choose
Bi-Weekly
Monthly
Other
If you are already making payroll contributions, the contribution on this form is meant to:
Be an additional contribution to the current one.
Change just the amount or designation of the current contribution.
Completely cancel and override the current contribution.
I hereby authorize the UNM Foundation, Inc. to:
Deduct a gift each pay period until I notify you in writing to discontinue deductions, in the amount of:
Deduct a gift each pay period until my total gift is:
Deduct a ONE TIME gift, from my next paycheck in the amount of:
Please direct my gift (can choose more than one fund, please indicate dollar amount for each):
Alumni General Fund-200496
Alumni White Coat Fund-202234
Alumni Endowment Fund-878110
La Tierra Sagrada Society-201241
LTSS Physical Therapy Scholarship Fund-203077
LTSS Physician Assistant Scholarship Fund-203078
LTSS Occupational Therapy Scholarship Fund-203079
Please type signature and date below:
Signature
Date
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
November 2024
>
<<
November 2024
27
28
29
30
31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
1
2
3
4
5
6
7
Please Wait...
Mobile Menu
Close
Search Content: