STUDENT PAYCHECK "PICK-UP" FORM

Please indicate by checking one box below and filling in the appropriate information.

Name: NCC ID#:

(Please Print)

I would like this Pick-up change to begin on:

(Date)
Please Check One:

Campus Mailbox #:

Hold for Pick-up in the Office of Human Resources

Other:
Address: Apt #:

City: State: Zip:

Please Check One:

Summer Term Only

Interim Term Only

Spring Break Only

Summer Term Only

Additional Instructions:
Supervisor Pick-up:

Supervisor Name: Department:

(Please Print)
NOTE: At the end of the current academic year (Spring term), this form will be voided and all paychecks will
be mailed to your permanent address, unless the Office of Human Resources is notified otherwise.

Signature: Phone: Date:

Please return this completed form to the Office of Human Resources, OM507 or Campus Mailbox #274.
30 N Brainard St Naperville, Illinois 60540 630-637-5757 Fax 630-637-5755 www.northcentralcollege.edu