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First Name: |
Last Name: |
Rank: |
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| Department or Unit: |
Dept Phone#: |
College: |
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| Tenured:
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| Current Committee & Work Group Assignments: |
Years Remaining: |
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I do not
wish to be assigned to a committee or work group.
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| Please provide justification below: |
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| Requested Assignment |
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| 1st Choice:
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2nd Choice:
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3rd Choice:
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