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Evaluation Coordinator Update Form

Please use this form to update our office on any changes to your assignment of Evaluation Coordinator duties within your department or program office.

Required fields are marked with a red dot next to them.

Previous Evaluation Coordinator

Name of the person being replaced. (optional)

Information Below is for the NEW Evaluation Coordinator (Required)

Please indicate when this change will go into effect. If the change has already been made, you may put today's date.

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First Name (Required)

Last Name (Required)

Department / Program (Required)

Office Room No. & Building (Required)

Campus Mail Code (Required)

Phone Ext. (Required)

Fax No. (Required)

E-mail address (Required)

Comments

Maximum of 1,000 characters.

characters remaining

When submitted, the next screen will summarize your input for your review and an e-mail will be sent to the EIP Office with the updated information.