{"id":607,"date":"2016-09-13T12:47:42","date_gmt":"2016-09-13T12:47:42","guid":{"rendered":"https:\/\/www.berea.edu\/give\/?page_id=607"},"modified":"2020-08-21T09:18:32","modified_gmt":"2020-08-21T13:18:32","slug":"payroll-deduction-form","status":"publish","type":"page","link":"https:\/\/legacy.berea.edu\/give\/payroll-deduction-form\/","title":{"rendered":"Payroll Deduction Form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_3' >\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/give\/wp-json\/wp\/v2\/pages\/607' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_3' class='gform_fields top_label form_sublabel_above description_above validation_below'><li id=\"field_3_11\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_11\" ><h2 class=\"gsection_title\">Personal Information<\/h2><\/li><li id=\"field_3_4\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_4\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_4'>\n                            \n                            <span id='input_3_4_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_3_4_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_4.3' id='input_3_4_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_3_4_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_3_4_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_4.6' id='input_3_4_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><li id=\"field_3_20\" class=\"gfield gfield--type-text field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_20\" ><label class='gfield_label gform-field-label' for='input_3_20'>Banner ID<\/label><div class='gfield_description' id='gfield_description_3_20'>Also known as B Number<\/div><div class='ginput_container ginput_container_text'><input name='input_20' id='input_3_20' type='text' value='' class='medium' maxlength='9' aria-describedby=\"gfield_description_3_20\"    aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_6\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_6\" ><label class='gfield_label gform-field-label' for='input_3_6'>CPO<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_3_6' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_5\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_5\" ><label class='gfield_label gform-field-label' for='input_3_5'>Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_3_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-describedby=\"group-err\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_12\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_12\" ><h2 class=\"gsection_title\">Gift Information<\/h2><\/li><li id=\"field_3_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_1\" ><label class='gfield_label gform-field-label' >Please designate my gift for:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_1'>\n\t\t\t<li class='gchoice gchoice_3_1_0'>\n\t\t\t\t<input name='input_1' type='radio' value='Berea Fund (Tuition Promise Scholarships)'  id='choice_3_1_0'    \/>\n\t\t\t\t<label for='choice_3_1_0' id='label_3_1_0' class='gform-field-label gform-field-label--type-inline'>Berea Fund (Tuition Promise Scholarships)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_1_1'>\n\t\t\t\t<input name='input_1' type='radio' value='Named Endowed Fund'  id='choice_3_1_1'    \/>\n\t\t\t\t<label for='choice_3_1_1' id='label_3_1_1' class='gform-field-label gform-field-label--type-inline'>Named Endowed Fund<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_1_2'>\n\t\t\t\t<input name='input_1' type='radio' value='Program or Department'  id='choice_3_1_2'    \/>\n\t\t\t\t<label for='choice_3_1_2' id='label_3_1_2' class='gform-field-label gform-field-label--type-inline'>Program or Department<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_2\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_2\" ><label class='gfield_label gform-field-label' for='input_3_2'>If you selected Named Endowed Fund or Program or Department, list below:<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_3_2' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_13\" class=\"gfield gfield--type-number field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_3_13\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_3_13'>I authorize Berea to deduct the requested amount per payroll.<\/label><div class='ginput_container ginput_container_number'><input name='input_13' id='input_3_13' type='text' step='any'   value='' class='medium'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_21\" ><label class='gfield_label gform-field-label' >I authorize Berea to deduct the following amount per payroll:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_21'>\n\t\t\t<li class='gchoice gchoice_3_21_0'>\n\t\t\t\t<input name='input_21' type='radio' value='5'  id='choice_3_21_0'    \/>\n\t\t\t\t<label for='choice_3_21_0' id='label_3_21_0' class='gform-field-label gform-field-label--type-inline'>$5<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_21_1'>\n\t\t\t\t<input name='input_21' type='radio' value='10'  id='choice_3_21_1'    \/>\n\t\t\t\t<label for='choice_3_21_1' id='label_3_21_1' class='gform-field-label gform-field-label--type-inline'>$10<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_21_2'>\n\t\t\t\t<input name='input_21' type='radio' value='25'  id='choice_3_21_2'    \/>\n\t\t\t\t<label for='choice_3_21_2' id='label_3_21_2' class='gform-field-label gform-field-label--type-inline'>$25<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_21_3'>\n\t\t\t\t<input name='input_21' type='radio' value='50'  id='choice_3_21_3'    \/>\n\t\t\t\t<label for='choice_3_21_3' id='label_3_21_3' class='gform-field-label gform-field-label--type-inline'>$50<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_21_4'>\n\t\t\t\t<input name='input_21' type='radio' value='gf_other_choice'  id='choice_3_21_4'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_3_21_other' name='input_21_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_14\" ><label class='gfield_label gform-field-label' >I receive checks<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_14'>\n\t\t\t<li class='gchoice gchoice_3_14_0'>\n\t\t\t\t<input name='input_14' type='radio' value='Bi-weekly'  id='choice_3_14_0'    \/>\n\t\t\t\t<label for='choice_3_14_0' id='label_3_14_0' class='gform-field-label gform-field-label--type-inline'>Bi-weekly<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_14_1'>\n\t\t\t\t<input name='input_14' type='radio' value='Monthly'  id='choice_3_14_1'    \/>\n\t\t\t\t<label for='choice_3_14_1' id='label_3_14_1' class='gform-field-label gform-field-label--type-inline'>Monthly<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_15\" ><label class='gfield_label gform-field-label' >I am a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_15'>\n\t\t\t<li class='gchoice gchoice_3_15_0'>\n\t\t\t\t<input name='input_15' type='radio' value='9-month employee'  id='choice_3_15_0'    \/>\n\t\t\t\t<label for='choice_3_15_0' id='label_3_15_0' class='gform-field-label gform-field-label--type-inline'>9-month employee<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_15_1'>\n\t\t\t\t<input name='input_15' type='radio' value='10-month employee'  id='choice_3_15_1'    \/>\n\t\t\t\t<label for='choice_3_15_1' id='label_3_15_1' class='gform-field-label gform-field-label--type-inline'>10-month employee<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_15_2'>\n\t\t\t\t<input name='input_15' type='radio' value='12-month employee'  id='choice_3_15_2'    \/>\n\t\t\t\t<label for='choice_3_15_2' id='label_3_15_2' class='gform-field-label gform-field-label--type-inline'>12-month employee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_9\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_9\" ><h2 class=\"gsection_title\">Gifts is in Memory or Honor<\/h2><\/li><li id=\"field_3_7\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_7\" ><label class='gfield_label gform-field-label' >Please make my gift (optional):<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_7'>\n\t\t\t<li class='gchoice gchoice_3_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='In honor of:'  id='choice_3_7_0'    \/>\n\t\t\t\t<label for='choice_3_7_0' id='label_3_7_0' class='gform-field-label gform-field-label--type-inline'>In honor of:<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='In memory of:'  id='choice_3_7_1'    \/>\n\t\t\t\t<label for='choice_3_7_1' id='label_3_7_1' class='gform-field-label gform-field-label--type-inline'>In memory of:<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_8\" class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_8\" ><label class='gfield_label gform-field-label' for='input_3_8'>Full name of person that you are making the gift in honor or memory of:<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_3_8' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_10\" class=\"gfield gfield--type-address field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_10\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address of Honoree<\/label>    \n                    <div class='ginput_complex ginput_container has_city has_state ginput_container_address gform-grid-row' id='input_3_10' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_10_3_container' >\n                                    <label for='input_3_10_3' id='input_3_10_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_10.3' id='input_3_10_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_10_4_container' >\n                                        <label for='input_3_10_4' id='input_3_10_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_10.4' id='input_3_10_4' value=''      aria-required='false'    \/>\n                                      <\/span><input type='hidden' class='gform_hidden' name='input_10.6' id='input_3_10_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_3_16\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_16\" ><h2 class=\"gsection_title\">Confirmation<\/h2><\/li><li id=\"field_3_17\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_17\" ><label class='gfield_label gform-field-label' for='input_3_17'>By initialing below, I authorize Berea College to continue my payroll deduction until further notice. I understand that I may discontinue this agreement at any time.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_3_17' type='text' value='' class='medium' maxlength='3'    aria-required=\"true\" aria-describedby=\"group-err\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_18\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_18\" ><label class='gfield_label gform-field-label' for='input_3_18'>Signature (by typing your name here you are authorizing this agreement)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_3_18' type='text' value='' class='medium'     aria-required=\"true\" aria-describedby=\"group-err\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_19\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_19\" ><label class='gfield_label gform-field-label' for='input_3_19'>Comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_3_19' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_22\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_22\" ><label class='gfield_label gform-field-label' for='input_3_22'>Name<\/label><div class='gfield_description' id='gfield_description_3_22'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_22' id='input_3_22' type='text' value='' autocomplete='new-password'\/><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_3\"]){return false;}  if( !jQuery(\"#gform_3\")[0].checkValidity || jQuery(\"#gform_3\")[0].checkValidity()){window[\"gf_submitting_3\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_3\"]){return false;} if( !jQuery(\"#gform_3\")[0].checkValidity || jQuery(\"#gform_3\")[0].checkValidity()){window[\"gf_submitting_3\"]=true;}  jQuery(\"#gform_3\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            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