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Your Name

Department Name

Number of Changes

Does the change only impact one person?

Effective Month

What reconciliation month should this modification go into effect?

Modification Type

Employee Last Name

Last name of the employee that is having their role modified.

Employee First Name

First name of the employee that is having their role modified.

Employee ID #

STARS Role

Speedtypes Affected

Should this affect all departmental speedtypes or specific speedtypes?