DATE: ______________________
PHONE:
4-2534
FAX:
MAILCODE:
4-8811
0175 – I
AUTHORIZATION TO ADD or DELETE INDEX NUMBERS
ORIGINATING DEPARTMENT: ___________________________________________ MAILCODE: ________________
CONTACT PERSON: ______________________________________________ PHONE EXT: _____________________ FAX NUM: ____________________
DEPARTMENT APPROVAL: _____________________________________ AUTHORIZED SIGNATURE: __________________________________________
(PLEASE TYPE OR PRINT)
INSTRUCTIONS: PLEASE PRINT CLEARLY & FILL OUT FORM COMPLETELY! FORMS THAT ARE NOT FILLED OUT CORRECTLY WILL BE RETURNED
1. Please indicate the full name on the card or “global.” Please note global should only be used when globally deleting or replacing index numbers, not adding.
2. Check appropriate column based on the type of card (E for Employee ID, S for Student ID, A for Affiliate ID, D for Department green card)
3. Please list the Employee ID, Student PID, Affiliate ID or Department Green Copy Card number in the ID column.
4. Indicate which index numbers are to be added and/or deleted in the appropriate column(s).
5. Fax form to Clarissa Bash at 4-8811. Forms received BY 2 PM will be processed that day and ready to use at 4 PM.
NAME or
“GLOBAL”
(REQUIRED)
E
S
A
(REQUIRED)
D
ID #
(REQUIRED)
ADD
INDEX #
(REQUIRED)
DELETE
INDEX #
(REQUIRED)
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REVISED 08/20/13