DCS Payroll Deduction Together, we can help increase student achievement! Levels of Support * The contributions indicated below are for the current school year and every year thereafter provided that I may revoke this authorization by giving written notice to that effect. $25 Annually ($2.09 per pay period) $50 Annually ($4.17 per pay period) $100 Annually ($8.34 per pay period) $250 Annually ($20.84 per pay period) Alternative Donation Amount Name * First Name Last Name School * Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Signature (enter full name for signature) * Authorization * Check Here to Confirm Signature Thank you!
