Voluntary Deduction Form - Foothill-De Anza Community College District Faculty Association Political Action Committee

I am a*

Monthly Contribution*

I authorize the Foothill-De Anza Community College District to deduct from my salary the amount designated below to be used by the Political Action Committee of the Faculty Association.

Monthly Contribution*

I already am a contributor, please adjust my deduction to the amount indicated.

Full Name*

First Last

Campus ID*

College*

Division / Department

I am*

Full-Time
Part-Time

First year employed by FHDA CCD

Email*

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Communication and Involvement*

I would like to get involved with the FA PAC.
I would you like to receive regular updates on FA PAC work.
I do not want to be contacted by the FA PAC.

Consent*

I agree to submit this voluntary deduction form to FHDA payroll.

The Faculty Association Political Action Committee is responsible for developing and executing programs of sound political education which encourage faculty to exercise their full rights and responsibilities as citizens and to take their rightful place in the political life of our campuses and our local, state, and national communities.

Name

This field is for validation purposes and should be left unchanged.