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Lewis and Clark
Employee Giving - Payroll Deduction Form
For questions, contact Advancement. Email: giving@lclark.edu Phone: x7900
First Name*
Preferred First Name
Last Name*
LC ID*
LC Email Address*
Campus Department*
MSC*
Campus Phone*
Payroll Deduction
Is this a new deduction or update to a current deduction?*
New deduction
Update to current deduction
Lewis & Clark Fund Designation
Amount per Paycheck
Start Date
Deductions are ongoing unless updated or canceled by employee
Required Authorization
Electronic Signature*
Type full name
Verify and Authorize*
By checking this box and signing my name above, I authorize Lewis & Clark College to withhold the amounts indicated above from each paycheck. I understand that deductions made to Lewis & Clark are ongoing without end unless changed by me.
Submit
