Dr. Mr. Ms. Name
Last First Middle Int. A #
Employee's Birthday Spouse's Name
Home Telephone Number
Work Phone Number Office Location
Campus E-Mail Address
Education (example: B.S. 1997, Lake Superior State University; M.B.A. 1999, Lake
Superior State University)
I would like to be listed in the LSSU web site personnel directory.
In addition, photographs are included on the LSSU web site personnel directory. Do you want your
photograph on the web site personnel directory?
For Human Resources Office Use.
Employee Group: A/P ESP FAC
Web Updated __________