Voluntary Payroll Deduction

Santa Rosa Junior College's Voluntary Payroll Deduction Program allows you to make a significant gift to SRJC by dividing your contribution into smaller portions paid throughout the year.

Each month your donation will be deducted automatically from your paycheck. Voluntary Payroll Deduction is an affordable way to make a difference for those programs or scholarships you wish to support.

When you contribute $20 a month (or more), you'll receive a commemorative 100th Anniversary pin to wear with pride around campus and in the community.

Yes! I wish to support SRJC through a monthly payroll deduction!

Gift Information:*

New monthly deduction
Add/Increase my current deductions
One-time deduction

Payroll Schedule:*

10 month
12 month

Designate Your Gift

If you wish to designate your gift to a particular fund (i.e. a named scholarship, program or department), please specify below. If you wish to give to the area of greatest need, please select that option.:

Program
Scholarship
Department
Unrestricted/Area of Greatest Need

Name of specific program, scholarship or department fund (if applicable):

Monthly Donation Amount:*

Start Date (1st day of next month):*

Permission to publicize name in donor recognition materials:*

YesNo

Your SRJC employee ID number (or last 4 digits of Social Security number):*

I authorize the Payroll Office to deduct this amount from my wages. :*

YesNo

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country:*

Mobile Phone:

Home Phone:

Email:*

Fields marked * require an entry.