Payroll Donation

If you are an employee of Pasco County Schools and would like to contribute through payroll deduction please complete the following form.

Employee Name
School/Worksite
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Payroll Deduction: I want to help the students and staff of Pasco County Schools. Please deduct the amount I have checked each pay period until changed by me.

Payroll Deduction: I want to help the students and staff of Pasco County Schools. Please deduct the amount I have checked each pay period until changed by me. $1 $2 $5 $10 $25 Other Other
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY