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SJECCD Employee Payroll Deduction Cancellation
Please fill out the form below to request cancellation of your payroll deduction.
For more
information,
please contact the Foundation at 408.918.5144 or
foundation@sjeccd.edu
.
You will receive a confirmation of your pledge cancellation via email in 3-5 business days.
Thank you!
Foundation Team
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* Indicates required question
Name
*
Your answer
Employee Number
*
Your answer
Email Address
*
Your answer
Address
*
Your answer
Phone Number
Your answer
Affiliation
*
District
EVC
SJCC
Date Cancellation Effective
*
MM
/
DD
/
YYYY
Pledge Information
*
Cancel Pledge
I authorize the Foundation to cancel my annual pledge through a payroll deduction every pay period as a tax-deductible donation to the SJECCD Foundation.
*
Authorized
Not Authorized
I authorize the action indicated on this form with my virtual signature. Please type your full name.
*
Your answer
Date Signed
*
MM
/
DD
/
YYYY
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