Liaison/Area Contact Information Form

If you are an Area Contact, complete the form and indicate your role in Question 1.

Will you be the liaison for your department on a permanent basis?	Yes No, I am the liaison on an interim basis. Important: be sure the next assigned liaison completes this form. No, my role will be as Area Contact.
Your Name:
Department:
Mailing Address:
Telephone Number:
UGA E-mail Address:
Secondary Contact Name:
Secondary Contact E-mail Address:
Secondary Contact Phone:
Building Number:
Department Home Code:
Distribution Code: Code for Payroll to distribute checks
Department Web Address:
Did your department hire any students through FWS in the current academic year?	Yes No
How many students are currently employed in your department? If you are not currently participating, how many do you hope to have employed for the upcoming year in your department?	None/Considering participation 1-2 3-5 6-10 11+