Salary Deduction Authorization Form
To The Board of Education of the Willard R-2 School District:
From:________________________________________________ (print your name here)
You are hereby authorized to deduct $ _______________________________________ from my salary, the total amount necessary to cover the items marked below.
(_____) Local M-NEA Teachers Association $ _________________
(_____) Local MSTA Teacher Association $__________________
(_____) Missouri National Education Association $__________________
(_____) Missouri State Teachers Association $_________________
(_____) Willard American Federation of Teachers $__________________
(_____) Willard Federation of Classified Employees $___________________
(_____) Willard Children’s Charitable Foundation $__________________
$1 $2 $5 $10 (please circle and indicate above for WCCF only)
(_____) Willard Tiger Cubs Preschool Tuition $___________________
I agree that deductions shall be made in equal monthly installment each year beginning in September or, for the first year, beginning after the next month after this form is signed.
Signature: ___________________________________________ Date:___________________