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AUTHORIZATION AGREEMENT FOR THE DIRECT DEPOSIT OF
FEDERAL WORK-STUDY STUDENT PAYROLL FUNDS
TO A STUDENT TUITION ACCOUNT

I authorize University of the Cumberlands to initiate payroll related credit entries to my student tuition account in lieu of me receiving the payroll payment in the form of a paycheck.

This authorization is to remain in effect for the remainder of the academic year or until the University’s Human Resources Office receives written notice from me of its cancellation.  Any change in this direct deposit arrangement must be made by the 4th of each month for the following payroll, or by the 19th of each month for the following payroll, which allows the University time to process the request.  This is a request for the withholding or diversion of wages in compliance with section 337.060 of the Kentucky Revised Statutes.

First Name Last Name
Student ID Number Email

Student Signature Date
Parent Signature
(If student under 18 years old)
Date