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Government of the Virgin Islands UVI Payroll Deduction Form

GVI UVI Payroll Deduction Form

This is a secured web site. Complete the following secure form in order to donate to UVI. Please note, all fields are required.

This field is mandatory.

1. Date (MMDDYYYY)

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2. Name

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3. Mailing Address Line 1

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4. Mailing Address Line 2

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5. Island St. Croix St. Thomas St. John

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6. Zip Code

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7. Email Address

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8. Cell Number (340-555-0000)

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9. Work Number (340-555-0000)

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10. Employee Number

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11. Government Agency

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12. Department/Section

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13. Action Requested: Choose only one from the following. New Change Stop Recurring

14. For New: Deduct the following amount each pay period.

15. For Change: Change my deduction to the following amount each pay period.

16. For Cancellations: I wish to discontinue my deduction of the following amount

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17. Select your preference for use of your gift below. Annual Giving Scholarship STT Annual Giving Scholarship STX International Student Scholarships Athletic Scholarships Foundation for the University of the Virgin Islands-University Endowment Reichhold Center for the Arts Reserve Officer's-Training Corps (ROTC) Summer Enrichment-Business Program Summer Enrichment-Math & Science Programs UVI Community Engagement Life Learning Programs (UVICELL) VIEPSCoR-Research Area of Greatest Need

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18. Type Name Here: E-Authorize. By sending this form, I authorize the University of the Virgin Islands and the Government of the Virgin Islands Department of Finance to the above payroll deduction agreement.

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19. I understand and agree with the terms and conditions of the UVI/VIG payroll deduction program.

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