Faculty and Staff Payroll Deduction-Supporting Student Success

Please fill out the form below to make a gift via payroll deduction.

Name Name First Last
University Email
Department
Home Address Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Spouse's Name Spouse's Name First Last
Spouse's Employer (Please check www.matchinggifts.com/newhaven to see if your spouse works for a matching gift company.)
Relationship to the University (mark all that apply)

Relationship to the University (mark all that apply) Faculty Staff Adjunct Faculty Alumna/us Spouse is an alumna/us Parent of a current University of New Haven student Parent of a University of New Haven alumna/us
Gift Information

I wish to schedule my gift through payroll deduction below:
I wish to designate my gift to:

I wish to designate my gift to: Centennial Scholarship Fund Annual Fund (unrestricted) Students First Fund Charger Athletics Pompea College of Business Dean's Excellence Fund College of Arts and Sciences Dean's Excellence Fund School of Health Sciences Dean's Excellence Fund Tagliatela College of Engineering Dean's Excellence Fund Henry C. Lee College of Criminal Justice and Forensic Sciences Dean's Excellence Fund Other Other
I hereby authorize the University of New Haven to deduct (the below amount) per paycheck. I understand that all payroll deductions will begin on the 15th of the following month and remain in effect until I notify the Annual Giving Office of my intent to change or stop. $ Dollars . Cents
I am paid:

I am paid: Weekly Bi-Monthly
Please draw your signature into the box below using your mouse (computer) or finger (mobile device)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Questions? Contact Alex Salzano, a Assistant Director of Annual Giving at asalzano@newhaven.edu or 203-479-4114.
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Faculty and Staff Payroll Deduction-Supporting Student Success

Faculty and Staff Payroll Deduction-Supporting Student Success

Gift Information

Questions? Contact Alex Salzano, a Assistant Director of Annual Giving at asalzano@newhaven.edu or 203-479-4114.