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Use this form to notify HR and Student Employment of a change in supervisor.
A change of ten (10) or more employees in the same department may be sent directly to
; all data fields below must be included on the request.
Requestor Email Address:
Requestor UA Phone:
FT Contract Professional
PT Contract Professional
Old Supervisor Name:
New Supervisor Name:
New Supervisor EmplID:
Reason for Change:
Effective Date of Change: (mm/dd/yyyy)
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