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

 
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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.

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