Purpose of submission / notification

(Note: A help desk ticket only needs to be completed/submitted if the “change” involves and IT-related need. Changes such as food allowances; DOB corrections; salary adjustments; etc. do not require a ticket to be submitted to the IT department.

Last Name:

First Name:

Street Address:

City:

State:

Zip Code:

Telephone:

Current E-Mail Address (often a personal email address such as Gmail, Yahoo, etc...):

Arch-based E-Mail address:

(Note: Policy per BSN is to allow the account to remain open 60 days after term date at which time account will be closed/deleted. Archives/Records should be notified once term request is placed as “some” accounts may need to remain open for a longer period of time than 60 days)

Type of Priest:

If other than Diocesan, please specify in comment field below

Assignment Location:

Assignment Position:

Effective Date: