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Arts & Sciences Staff Addendum Request

Request Type *

Additional Temporary Pay

Change of Working Title

Change of Reports To

Change/Correct Start Date

Department Name/Org# *

PROGRAM COORDINATOR INFORMATION

First Name *

Last Name *

Campus Email *

UNIT CHAIR/DIRECTOR INFORMATION

First Name *

Last Name *

Campus Email *

Number of Employees Receiving Additional Pay *

Leave this field blank

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