UCR Employee Payroll Deduction Form

Use this form to enroll or change your voluntary charitable giving through payroll deduction.

Important Guidelines:

  • Employees can only have one total payroll deduction active at a time.
  • If an employee has an active deduction, submitting this form for a new amount or fund will automatically replace and cancel your previous one.
  • An ongoing payroll deduction will remain in effect continuously until the employee requests to cancel it, or employment with UCR ends.
Questions? For support with payroll deductions or pledges, please contact the Gift Administration Team at ucrgifts@ucr.edu.

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Email *
Name *
As it appears on payroll.
Employee ID *
You can find it on the UCPath website.
What would you like to do? *
If you have a current deduction it will be replaced by the deduction you indicate below after you submit and it's been reviewed. (It may take 1-2 pay cycles to take effect).
Choose a Fund Designation(s) *
Required
Monthly amount to be deducted *
If you are paid bi-weekly, this amount will be split over your paychecks each month.
How long should this deduction continue? *
If you would like to donate a lump sum, choose Other for a declining payroll deduction. Please type, $____ Monthly payroll deduction until my pledge of $______ is fulfilled.
(Optional) Additional comments or care to share what motivated you to give?
Employee Authorization & Acknowledgement *

By submitting this form, I hereby authorize UCPATH to initiate or terminate payroll deductions as indicated above. I understand and agree to the following:

  • Authorization: I authorize the specified changes to my gross earnings in accordance with the schedules and amounts provided.

  • Effective Date: Requested changes will be processed in the next available pay cycle, subject to standard administrative processing times.

  • Duration: For new deductions, this authorization shall remain in full force and effect until I submit a request for termination or until the total specified obligation is met.

  • Accuracy: I certify that the information provided is accurate and that I am the authorized account holder or beneficiary for this request.

Confirmation: Selecting "I Agree" and clicking "Submit" constitutes my electronic signature and confirms my intent to modify my payroll records as described.
A copy of your responses will be emailed to the address you provided.
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