San Juan Education Foundation Payroll Deduction Form

San Juan Education Foundation Payroll Deduction Form

Please use this form to initiate, change or cancel your payroll deduction for the San Juan Education Foundation. Forms must be received in the Benefits Department by the 5th of the month in order for the payroll deduction to occur at the end of the month.
Name*

First NameLast Name
Employee ID Number or last four digits of your Social Security Number (SSN)*
Home Address*
Work Site Location*
Work Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Payroll deduction option (select one only)*

New deductionChange deductionCancel deduction
Amount of deduction ($). Deduction will be taken for each of your regular pay cycles.*
I wish to support the San Juan Education Foundation by a payroll deduction contribution. I hereby authorize San Juan Unified School District to deduct from my salaries/wages the amount specified. I understand that this payroll deduction will remain in effect until cancelled by me. Payroll deduction contributions may be tax-deductible. Please consult your tax advisor.
Signature*

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