Date:

Requested By:

E-mail: (use format name@udel.edu)

Department name for Supervisor Code:

If updating, Supervisor Code to update:

This is a request for a:

New Supervisor
Replacement of the Supervisor or Alternates
Replacement of the Final Approver or Alternates
Replacement of the Chair or Alternates
Replacement of the Dean/VP or Alternates

If replacement, please provide the name of the supervisor being replaced:

Comments:

	Name	Employee ID	Signature Authority*
Supervisor			Yes
1st Alternate			Yes
2nd Alternate			Yes
Final Approver			Yes
Final Appr 1st Alternate			Yes
Final Appr 2nd Alternate			Yes
Chair			Yes
Chair 1st Alternate			Yes
Chair 2nd Alternate			Yes
Dean/VP			Yes
Dean/VP 1st Alternate			Yes
Dean/VP 2nd Alternate			Yes

* Signature Authority default is "No." Please check "Yes" if applicable.

Please inactivate the following Supervisor Code:

Reason for inactivating code: