The Fund for Potsdam

New York State Payroll Deduction Authorization
The State University of New York - Potsdam College Foundation

Please submit this secure online form to begin payroll deduction or to change your existing payroll deduction amount. Please call Lisa Murphy at 315/267-3053 if you have any questions about the form. 

Employee Name: Foundation Code #836
Last 4 digits of social security #: Pay Stub Item #:

I am a: 21 pay/year faculty member
26 pay/year faculty member


Deduction:
Start deductions: Biweekly amount of $(minimum $1.00)
Change deduction to: Biweekly amount of $(minimum $1.00)

Please use my gift for:

 College's greatest needs
 Other (specific office, department or scholarship)

Agency - The State University of New York at Potsdam Code #28250

TO THE STATE COMPTROLLER: Pursuant to Section 201 of the state finance law, I hereby authorize you to deduct from each of my biweekly salary checks the deduction amount shown, for the purpose of my contributing to a campus-related foundation, and to transmit such withholding amount to the designated provider. I understand that this authorization may be revoked at any time by written notice filed with my payroll office.

To digitally "sign" this form, please enter your CCA username and password.

Username: Password: