Lawrence Township Education Foundation: Payroll Authorization

LTPS Faculty/Staff Campaign
Payroll Deduction Authorization for LTEF

Please print out this form, fill it in,
and send it via internal mail to
LTPS / Payroll Department / Administration Building
Your generous gift will be withdrawn from
each paycheck throughout the year.

I authorize a payroll deduction of $__________ each pay period starting ____/____/____.
(Please see schedule of payment amounts below)
Name: ________________________________________________________________________________

School: __________________________________ Department/Grade: _____________________________

Social Security Number: __________________________________________________

Home Address: ________________________________________________________________________

City: ____________________________________ State: _______________________ Zip:_____________

Home Phone: _____________________________ Work Phone: _________________________________

Signature: _____________________________________________________________________________

( ) I have enclosed a matching gift form from my spouse's company.

Deduction
per Paycheck

$1.00
$2.00
$3.00
$4.00

Total Gift

$ 20
$ 40
$ 60
$ 80

We appreciate your support!
Thank you form making the commitment to support the students of Lawrence Township Public Schools via payroll deduction. We look forward to hearing of your generosity and seeing your gifts at work in our classrooms. Contributions to LTEF are tax-deductible under the provisions of section 501(c)(3) of the Internal Revenue Code.