NAVUB Directory Information (Staff)
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Staff Member Name *
Is this staff member being added or removed from the directory? *
Staff Member Role *
Program Name *
Program Address *
Staff Member Phone Number (xxx) xxx-xxxx *
Staff Member Fax Number (xxx) xxx-xxxx (if applicable)
Staff Member Email Address *
Staff Member Start Date (Month/Year) *
Name of the Person Submitting this Form *
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