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I do hereby authorize the Mount Vernon School District No. 320 to deduct $______ from my monthly pay warrant until such authorization is terminated by me, in writing to the school district business office.

This deduction shall be forwarded to the Mount Vernon Scholarship Foundation Fund (A trust fund established at a chartered bank, Skagit State Bank, in Skagit County and the State of Washington), which shall then be the responsibility of the treasurer of the Mount Vernon Scholarship Foundation Fund. These scholarships are awarded to worthy seniors who graduate from Mount Vernon High School.

Please put this form in the District Office Mailbox ATTN: Lori McLeod (or for your convenience you could send it to Laurel Parker or Amy Weppler also)