Payroll Deduction Authorization – forms.montreat.edu

"*" indicates required fields

Academic Year*

Student Name*

Authorization of Payroll Deduction*

YES: I am eligible for Federal or Montreat Work Study funds (as determined by the Financial Aid Office) and voluntarily authorize payroll deduction of my earnings to be applied to my student account. I understand that I may rescind this authorization at any time by submitting a written request to the Student Accounts Office. If any payment due Montreat College has been deferred based on my potential earnings and I do not earn all the Work Study funds for which I am eligible by the semester’s end, I will pay any remaining balance on my account.

NO: I no longer wish to have my work study earnings applied to my student account through payroll deduction and rescind any prior authorization to do so. I understand that I am still responsible to pay Montreat College for any remaining balance on my student account that was previously deferred based on my potential work study earnings.

Please Choose One*

Fall Semester Only

Spring Semester Only

Both Fall & Spring Semesters

Amount to be paid to student account: (choose one)

All workstudy earned

% of workstudy earned

$ of workstudy earned

Other

What % of workstudy earnings do you want to pay to your student account?*

What $ amount from workstudy earnings do you want to pay to your student account?*

Student Electronic Signature*

I agree and acknowledge that this document can be executed electronically and it is binding in every way as if signed by my hand.

Student Electronic Signature: Date*

Student ID*