First Name:   Last Name:

Employee
Giving

Mailing Address:
City:   State:   Zip:
Campus Extension:   Home Phone:
Email:
Job Title:
Length of service with NSU:

I advise the Payroll Department of the Business Affairs Offices to make the following deduction from my payroll check. This represents a gift to The Northeastern State University Foundation, Inc.
Please deduct $ each pay period.
(This will continue until a change is made in the deduction form or until the deduction is terminated in writing).

This deduction is to begin:

immediately.
with my (mm/yyyy) paycheck.
SSN: - -
Date of Birth: (mm/dd/yyyy) / /
Please direct my NSU Annual Fund Donation to:

Where the need is greatest

Campus beautification

General scholarships (Or you may designate a specific scholarship )

College of:
Business and Technology
Education
Liberal Arts
Optometry
Science and Health Professions
Athletics (You may specify a sport or area )

Other:

No information on this page will be stored on the server or saved in cache
 and will go directly to the Foundation.