Organizational Change Form

This form should be completed by the supervisor of the employee(s) affected by an organizational change at least two weeks prior to the effective date of change; if you need assistance completing this form, please contact the Office of Human Resources (ext. 2285).  When you submit this form and any appropriate documents, it will be sent to your Cabinet Vice President; after his / her approval, it will be routed to the Office of Human Resources.

  • Employee / Department Information

  • Employee's Name: * Required
  • Supervisor's Name: * Required
  • Reviewer's Name: * Required
  • Nature of the Change

  • Title Change
  • Supervisor Change:
  • New Supervisor Name:
  • Department Transfer:
  • Where a department or individual moves to (location / building & room #)
  • Date Format: MM slash DD slash YYYY
  • Supporting Documentation

  • Position Description updated in careers.
  • Additional supporting documentation attached (see below).
  • Comments

  • Requester

  • Name of Requester * Required