Please use this form to update our office on any changes to your assignment of Evaluation Coordinator duties within your department or program office. Previous Evaluation Coordinator Name of the person being replaced. (optional) Information Below is for the NEW Evaluation Coordinator * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20152016201720182019202020212022 Please indicate when this change will go into effect. If the change has already been made, you may put today's date. First Name * Last Name * Department / Program * Office Room No. & Building * Campus Mail Code * Phone Ext. * Fax Number * E-mail Address * Comments Maximum of 1,000 characters.