Payroll Deduction Information Request

Student Information

Unique ID:
  
(On the back of DukeCard)

Note: For security reasons, please do not send us your social security number or student ID number
First Name:
   		Last Name:
  
E-mail address:
  
(where we should direct your payroll deduction plan details for your confirmation)
Telephone Number:
   		 

 

Academic Information

DGS Assistant:

 

Terms in Attendance

SELECT ALL THAT APPLY

Summer 2008     Fall 2008
Spring 2009 Summer 2009

 

Payroll Information

Pay dates:

 

Additional Information or Comments:


IMPORTANT MESSAGE

Student's must update their insurance decision in ACES for the academic year before payroll deductions for the Fall term will be processed.

A Student Account Analyst will review your account and provide a payroll deduction plan schedule for you via email. No deduction will be submitted to the payroll office until you have authorized the proposed plan. Watch your email for your personal Payroll Deduction schedule. You should receive this within three business days.

 

TERMS & CONDITIONS

By submitting this form I authorize the Bursar's Office to make payroll deductions for the total amount and time period shown on the form above. I have read and agree to abide by the terms and conditions. Enrollment is subject to approval by the Bursar's Office.