SUNY Charitable Giving Campaign Payroll Deduction Form

Name

NYS Agency and Code Work Mailing Address

Note: You can give to the State University of New York campus of your choice through the SUNY Charitable Giving Campaign. You can designate your contribution to one or more SUNY campus.

DEDUCTION FORM

Deduction Code SUNY Campus Biweekly Total $ See SUNY Campus Deduction Codes below

Total* $

To Offi ce of the State Comptroller: I hereby authorize you to deduct from each of my biweekly salary checks the deduction amount shown below for the purpose of contributing to the designated SUNY campus or campuses and to transmit such withholding amount to the organization. I understand the authorization may be revoked at any time by written notice fi led with my payroll offi ce.

Select one: Start _____ $ X 26 = $ Change _____ Biweekly Total Payroll Periods Annual Total Cancel _____ *(Must match dollar amount in Biweekly Total column above)

Contributor’s Signature Date

Please return completed form to your payroll offi cer.

SUNY CAMPUS Deduction Codes

University Centers and Doctoral Degree Colleges of Technology 803 Herkimer County Community College Granting Institutions 841 Alfred State College 804 Hudson Valley Community College 821 University at Albany 842 SUNY Canton 805 Jamestown Community College 822 Binghamton University 843 SUNY Cobleskill 806 Jefferson Community College 823 University at Buffalo 844 SUNY Delhi 807 Mohawk Valley Community College 824 Stony Brook University 845 Farmingdale State College 808 Monroe Community College 838 SUNY Downstate Medical Center 846 Morrisville State College 809 Nassau Community College 839 College of Optometry 848 Maritime College 810 Niagara County Community College 840 Upstate Medical University 849 SUNYIT 811 North Country Community College 847 SUNY ESF 812 Onondaga Community College Community Colleges 813 Orange County Community College University Colleges 791 Adirondack Community College 814 Rockland Community College 825 Empire State College 792 Broome Community College 815 Schenectady County Community College 826 SUNY Brockport 793 Cayuga County Community College 816 Suffolk County Community College 827 Buffalo State College 794 Clinton Community College 817 Sullivan County Community College 828 SUNY Cortland 795 Columbia-Greene Community College 818 Tompkins Cortland Community College 829 SUNY Fredonia 796 Corning Community College 819 Ulster County Community College 830 SUNY Geneseo 797 Dutchess Community College 820 Westchester Community College 831 SUNY New Paltz 798 Erie Community College 832 Old Westbury 799 Finger Lakes Community College 833 College at Oneonta 800 Fashion Institute of Technology 834 SUNY Oswego 801 Fulton-Montgomery Community College 835 SUNY Plattsburgh 802 Genesee Community College 836 SUNY Potsdam 837 Purchase College