Public Schools Foundation of Tippecanoe County Payroll Deduction Sign Up Form

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for employees of the Tippecanoe School Corporation

Email *

Yes, I want to support the PSFTC payroll deduction program, and I authorize the Tippecanoe School Corporation (TSC) payroll department to deduct the amount below from my paychecks beginning with the first payroll in January. My donation will be given to the PSFTC each month via ACH transfer from TSC. My donation will be used to support the PSFTC Seeds for Excellence grant program.

$1 per pay period

$2 per pay period

$5 per pay period

$10 per pay period

$25 per pay period

Other:

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I would like to support this program with a ONE TIME donation to be deducted from the first pay period in January. Please enter the amount below.

Name *

Home Address (Street, City, Zip) *

Telephone *

School Building *

I understand that this contribution will continue until I notify the TSC payroll department to cancel the deduction or I am no longer employed by the TSC. *

I understand and accept these terms.

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A copy of your responses will be emailed to the address you provided.

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