Address Request Form

Be as specific as possible in your request; elaborate as necessary in the"Additional Instructions" field. Allow a minimum of five business days for your request to be filled.

Requestor Information
First & Last Name:
Email Address:
Phone Ext.
Date Needed
Date field must be completed. Allow at least 5 business days for your request to be filled.
What will these addresses be used for?
(Include a brief description of your project or need.)
Employee Selection Criteria
(Select any applicable)
Faculty Staff FT PT Deans, Directors & Dept Heads
Formal Names Casual Names
Special Criteria

Addresses for Labels
Campus Permanent Email
Formatting Comments:
How would you like the output sorted?
Alphabetical Department
Addresses will be delivered to you electronically in an excel spreadsheet.
Additional Instructions

Under the Family Educational and Privacy Act student data can only be released to:
"A properly designated school official for a legitimate educational purpose." By clicking submit I agree that this information will be employed only for the purpose for which it was requested and will not be released to any other individual or office for another purpose.