EmailMe Form - Giving - Faculty/Staff Change of Designation

Name *

First Last

Banner ID (T#)

Department

Email *

Phone

### - ### - ####

Changing a Designation

I am changing my gift designation.

FROM: College/School/Program

TO: College/School/Program

Adding a Designation

I am adding another designation.

College/School/Program

Amount:

Changing the Amount of my Designation

I am increasing my on-going payroll deduction

I am decreasing my on-going payroll deduction

I am cancelling my on-going deduction

FROM Amount:

TO: Amount:

Please discontinue my payroll deduction:

Discontinue immediately

Discontinue on a date I pick:

Date to discontinue deductions

MM / DD / YYYY

Signature of employee

NOTE: Your computer IP address along with the date and time will be recorded when you click "Sign and Submit"

Or sign by typing your name

Yes I want to electronically sign this form by typing my name.

Signature of employee (typing your name serves as your electronic signature).

NOTE: Your computer IP address along with the date and time will be recorded when you click "Sign and Submit"