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Payroll Deduction Form

Faculty and staff support of Kent State goes above and beyond the work we do every day and strengthens our university as a result. What sets us apart is how we come together.

Designate Your Payroll Deduction

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Search for a Fund (or enter a custom designation of your choosing)

Search for a Fund (or enter a custom designation of your choosing)

Designation ID

Gift Amount* (This will be your per pay amount if you choose to make a recurring gift. Total gift amount will be calculated below.)

Gift Frequency*

One Time

Recurring

What is Your Pay Schedule?

Twice per month (12-month cycle)

Every other week (12-month cycle)

Twice per month (10-month cycle)

Twice per month (9-month cycle)

Select the Duration of Your Gift

1 year

2 years

3 years

4 years

5 years

Total Gift Amount (calculated from options selected above)

Additional Gift Options

I’d Like To Give This Gift in Honor or Memory of Someone

Yes

Select the Type of Gift

In honor of...

In memory of...

Honoree First Name

Honoree Last Name

Would You Like Them to be Notified?

Yes

Name of Person Being Notified (Optional)

Country

Street

City

Region

Postal Code

Please Enter Your Personal Message (Optional)

Please Extend Donor Recognition to My Spouse/Partner

Yes

Spouse/Partner’s Name

My Spouse/Partner’s Employer Can Match My Gift

Yes

Spouse/Partner’s Name

Employer's Name

Your Information

First Name*

Last Name*

Your KSU Email Address*

Your Banner ID*

Phone Number*

Your Mailing Address

This should be your home/personal mailing address, not your campus address.*

Country

Street

City

Region

Postal Code

Electronic Signature

Your Department

Please Enter Your FLASHLINE ID (This will serve as an electronic signature for this form).*