Yes! I wish to support the efforts of the Shasta College Foundation through a monthly payroll deduction. 

* indicates a required field

Employee Name *

Address *

Effective Date *

Select a date from the calendar.

Payroll Deduction Amount: *

Authorization: *

By checking this box I agree to participate in the Voluntary Payroll Deduction program.

Validation *

Enter the characters in the image above to validate the form.