Payroll Deduction Gift Reply Form
My Gift is to support: (check one)
Areas of greatest need at: (specify School or College)
Areas of greatest need campus-wide.
Is this a joint gift? If so, please provide spouse’s name.
Monthly Gift Amount: $ No. of months (Minimum of $20 per month)
Dr. Mr. Mrs. Ms. Name Suffix
Campus Address Campus Ext.
An employee must be employed with UCLA for at least 50% time for a minimum of nine months to be eligible for payroll deduction.
Please return form to: Or Fax to:
UCLA External Affairs Alex Duran, Payroll Coordinator
Attn: Alex Duran, Payroll Coordinator (310) 794-3328
10920 Wilshire Blvd., Ste 950
Los Angeles, CA 90024