Belmont University Payroll Deduction Form

To establish, confirm or update your payroll deduction pledge, please complete the following form. This new annual pledge will become active on June 1 and extend through May 31. Thank you for your loyal support!

If you wish to make a one-time contribution, please click here.

Questions? Please call the Office of Development at 615-460-5517 or email development@belmont.edu.

First Name: *

Last Name: *

BUID: *

Department:

Email: *

Phone Number: *

Area Code Phone Number

Employee Type: *

Ten-month employee paid over 10 months Ten-month employee paid over 12 months Twelve-month employee paid over 12 months

Pay Schedule: *

Bi-Weekly Monthly

Check if you are an adjunct:

Adjunct Professor

Amount to be deducted each pay period: *

University Match: Belmont will match, dollar for dollar, gifts and pledges from current members of our faculty and staff donors to these funds:

University Match:

If you would like to split your payroll deduction across multiple match-eligible funds, please note the funds and amount to deduct for each below:

CLEAR

Or, choose from designation options below:

Area of Support (See next box for fund list)

Gift Designation (Scholarships):

Gift Designation (Missions):

Gift Designation (Athletics):

Gift Designation (Annual Fund):

Gift Designation (All):

If you would like to split your payroll deduction across multiple non-match-eligible funds, please note the funds and amount to deduct for each below:

Please contact Belmont University's Office of Development at (615) 460-5517 to discuss giving opportunities related to faculty support.

Other Gift Designation:

Start Date: *

New commitment - Deductions begin in the next fiscal year (June 2020). Upgrade existing commitment - Effective as of the next fiscal year (June 2020). Keep existing commitment – Deductions to continue as is through next fiscal year, June 2020 – May 2021 (please confirm amount to be deducted above). Change existing commitment - Effective as of the next fiscal year (June 2020).

Your commitment may be cancelled or changed at any time by notifying the Office of Development in writing. If you wish to make alternate arrangements, please describe below.

We are grateful for your support. Thank you for all you do for Belmont!

Gift Designation

Payroll Deduction Details