KCSD Faculty & Staff Alumni Membership & Payroll Deduction Form

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Thank you for your support of the Keystone Central Foundation.

Email *

Full Name

KCSD building(s) where you work? *

Home Mailing Address

Phone Number

What tax-deductible amount would you like to be deducted from each paycheck? *

$3.00

$5.00

$10.00

$15.00

Other:

By checking the box below, I agree to allow Keystone Central School District to deduct the above amount from each paycheck. I understand this is a tax-deductible contribution to the Keystone Central Foundation and it will continue until I make changes through the KCSD payroll department or I am no longer employed by the district. *

I read and agree to the terms above

Required

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