ACPS Payroll Deduction Form

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I want to support our ACPS students' college and career dreams through a 100% tax-deductible donation to fund scholarships for higher education.

Today's Date *

YYYY

Employee First Name: *

Employee Last Name:*

Employee E-mail ...@acps.k12.va.us *

Employee School or Location: *

Employee ID#: *

Social Security last 4 digits: *

Best Daytime Telephone (in case we need to reach you): *

Voluntary Deduction Dollar Amount per Payroll Period/Semi-Monthly: *

I hereby authorize the Alexandria City Public Schools payroll office to deduct from my salary the amount indicated below and designate these funds to the Scholarship Fund of Alexandria. I understand that the entire amount of my payroll deduction will support the General Fund of the Scholarship Fund that awards financial need-based scholarships to academically qualified, ACPS graduates to pursue higher education. The deduction will be effective for each payroll period following receipt of this authorization and will continue until further notice from me. A tax receipt will be issued annually.

$20

$10

Other:

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