GCLA

Information Information Authorization

GCLA - Gavilan College Latine Association

Monthly Automatic Payroll Deductions
GCLA Fees
$5.00 - Part-Time Classified/Full-Time Classified
$8.00 - Part-Time Faculty/Full-Time Faculty
$12.00 - Administrator/Board Member

Employee Information

Employee Name

First

Last

Address

Address Line 1

City

State

Zip Code

Gavilan ID-G#

GCLA Monthly Fee Type
$5.00 - Part-Time Classified/Full-Time Classified
$8.00 - Part-Time Faculty/Full-Time Faculty
$12.00 - Administrator/Board Member

My Monthly Contribution Information

Employee Giving Type.

Employee Pledge/Giving Amount

Questions or Concerns:

Contact: Jennifer Dinis, jdinis@gavilan.edu Anna Quinones, aquinones@gavilan.edu

Agreement

I hereby authorize the deduction as specified above from my wages. I am aware my Payroll deductions Auto-Renew unless Canceled. I understand and agree to the terms and conditions of the Gavilan College payroll deduction policy.

Your pay stub will serve as documentation of your monthly fee contribution.

Signature

Clear Signature

Giving Deduction Authorization

Your pay stub will serve as documentation of your monthly fee contribution.

Gavilan College Foundation is tax exempt under Internal Revenue Code Section 501(c)(3) charitable organization, Federal EIN/Tax ID: 77-0376063.. All donations are deemed tax-deductible absent any limitations on deductibility applicable to a particular taxpayer. No goods or services were provided in exchange for your contribution.

GCLA - Gavilan College Latine Association

Employee Information

My Monthly Contribution Information

Questions or Concerns:

Giving Deduction Authorization

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