Test Page

A Payroll deduction TEST

YES-I want to join with my colleagues and become a member of my local association, the Massachusetts Teachers Association, and the National Education Association. I hereby request and voluntarily accept membership in these associations, which shall continue on a voluntary basis from year to year. I agree to abide by the bylaws and constitutions of the associations. To support the associations' goals and to receive the advantages and benefits of membership, I agree to pay the full annual dues in each year of voluntary membership, owing at the start of each year and payable by payroll deduction, check, or other payment methods if available.*
- By checking the box at the left, I affirm that I understand and agree with the statement above. (Check box for digital signature)
TODAY'S DATE*
MM slash DD slash YYYY
Name*
First Middle Last
Home Address*
Street Address Address Line 2 City State ZIP Code
Phone*
The phone number is especially important for us all if there are problems with your payment.
Phone Type
- Home
- Work
- Cell
Email*
Personal email is preferred. We email a copy of your electronic submissions to you.
Enter Email Confirm Email
College*
Note: You may teach at more than one Massachusetts community college. In the following list, you should choose the one which sent you to this page. If this does not apply, choose the one at which you currently teach the most.
Ethnicity
Gender
Membership year.
- July 1, 2020 to June 30, 2021
Position:*
- Part-time Faculty (DCE and Day Part-time)
- Part-time Professional Staff
- Full-time Faculty
- Full-time Professional Staff
Semesters in which you expect to be teaching*
- Fall (September through December)
- Spring (January through May)
- Winter (Short Intersession)
- Summer 1
- Summer 2
Semesters in which you expect to be working*
- Fall (September through December)
- Spring (January through May)
- Winter (Short Intersession)
- Summer 1
- Summer 2
Date of Hire (Approximate is OK)*
MM slash DD slash YYYY

Dues for Full-time Members
You were hired during this time period
	07/01 – 11/14	11/15 – 01/31	02/01 – 04/14	04/15 – 06/30
Your Dues	$1032.00	$774.00	$516.00	$258.00
Dues Breakdown*
MCCC	$332.00	$249.00	$166.00	$83.00
MTA	$500.00	$375.00	$250.00	$125.00
NEA	$200.00	$150.00	$100.00	$50.00

Dues for Part-time Members
	If you expect to earn
	Under $9,000 per year	Over $9,000 per year
Your Dues	$218.00	$312.00
Dues Breakdown*
MCCC	$99.60	$99.60
MTA	$51.00	$102.00
NEA	$67.40	$110.40

PLEASE CHOOSE - If you expect to earn per year*
- Under $9,000
- Over $9,000
PLEASE CHOOSE
PLEASE SELECT THE TIME PERIOD WHICH INCLUDES YOUR DATE OF HIRE
- Full-Time Hired 07/01 – 11/14
- Full-Time Hired 11/01 – 01/31
- Full-Time Hired 02/01 – 04/14
- Full-Time Hired 04/15 – 06/30
Only for those who already pay MTA and/or NEA Elsewhere
I already pay MTA or NEA dues at another school or college. If you pay any of these dues/fees through another MTA/NEA-AFFILIATED school system, pay only the MCCC and/or MTA and/or NEA dues which you do not already pay.
- MTA
- NEA
Only for those who already pay MTA and/or NEA Elsewhere
I already pay MTA or NEA dues at another school or college. If you pay any of these dues/fees through another MTA/NEA-AFFILIATED school system, pay only the MCCC and/or MTA and/or NEA dues which you do not already pay.
- MTA
- NEA
Only for those who already pay MTA and/or NEA Elsewhere
I already pay MTA or NEA dues at another school or college. If you pay any of these dues/fees through another MTA/NEA-AFFILIATED school system, pay only the MCCC and/or MTA and/or NEA dues which you do not already pay.
- MTA
- NEA
Only for those who already pay MTA and/or NEA Elsewhere
I already pay MTA or NEA dues at another school or college. If you pay any of these dues/fees through another MTA/NEA-AFFILIATED school system, pay only the MCCC and/or MTA and/or NEA dues which you do not already pay.
- MTA
- NEA
Only for those who already pay MTA and/or NEA Elsewhere
I already pay MTA or NEA dues at another school or college. If you pay any of these dues/fees through another MTA/NEA-AFFILIATED school system, pay only the MCCC and/or MTA and/or NEA dues which you do not already pay.
- MTA
- NEA
Only for those who already pay MTA and/or NEA Elsewhere
I already pay MTA or NEA dues at another school or college. If you pay any of these dues/fees through another MTA/NEA-AFFILIATED school system, pay only the MCCC and/or MTA and/or NEA dues which you do not already pay.
- MTA
- NEA
I pay MTA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay NEA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay MTA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay NEA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay MTA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay NEA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay MTA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay NEA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay MTA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay NEA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay MTA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
I pay NEA dues through:*
YOU MUST SUPPLY THE NAME OF THE SCHOOL SYSTEM OR COLLEGE FOR VERIFICATION
Total
$0.00
*MCCC membership includes membership in the Massachusetts Teachers Association (MTA) and the National Teachers Association (NEA). These large organizations provide services that the MCCC cannot provide, such as legal assistance. MTA membership comes with many cost saving benefits. Check out the MTAB (MTA Benefits) link on the MCCC home page.
I authorize my public employer,*
to deduct in each pay period a pro rate portion of the annual dues of the Massachusetts Community College Council the Massachusetts Teachers Association and the National Education Association. I understand that annual membership dues for the associations are subject to periodic change by the governing bodies of the associations, and I authorize the deduction of modified dues as may apply. This authorization shall be irrevocable for the period of one year from the anniversary date of authorization (unless my employment ends during the payroll year). Said authorization shall continue from year to year unless I revoke it by notifying the treasurer of the local association in writing and filing a copy of said notice with my employer.*
- By checking the box at the left, I affirm that I understand and agree with the statement above. (Check box for digital signature)
Name*
First Middle Last
The button below generates an authorization by you for payroll deduction. You will receive an email confirmation that you have elected this option. Dues/fees will be automatically deducted from your pay by your college until you notify us otherwise.

Test Page

A Payroll deduction TEST

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