Fillable Loss Of Credentials (Lansing Community College)

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Loss Of Credentials (Lansing Community College)

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Country of origin: US
File type: PDF

U.S.A. forms for Lansing Community College

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Directions
1. Enter your name, department name, and the name of your Administrative
Supervisor. Please use the department name and name of your Administrative
Supervisor for the position effected by the loss of your credential.
2. Complete the entire form, indicating which license/credential was lost, the name of
the issuing body for that credential, the date and reason it was lost, and the
position(s) you hold at LCC that are affected by this loss of license/credential.
3. Sign and date form. Electronic signatures are accepted.
4. Save the completed PDF as a new file.
5. Email the new file to your Administrative Supervisor and HR-Support@star.lcc.edu.
Name _________________________________ Department_______________
Administrative Supervisor _____________________________________________
Name of Credential Lost ______________________________________________
Name of Issuing Body of Credential ______________________________________
Date Credential Lost __________________________________________________
Reason Credential Was Lost ____________________________________________
Affected LCC Position(s) _______________________________________________
My electronic signature certifies that the above information is correct as of the
date listed below.
Signature____________________________ Date__________________
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Loss Of Credentials (Lansing Community College)

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Completed 24 July 2020

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