Skip survey header

Program Coordinator Change Request

1.

Coverage Type

*This question is required.

New Program Coordinator Information

This question requires a valid email address.
7.

Is this person new to your organization?

*This question is required.
8.

Is this person replacing an employee in your organization?

*This question is required.
9.

Is the person being replaced still employed with your organization?

*This question is required.

Authorized Individual Information

This question requires a valid email address.
Fund Member’s Program Coordinator shall have express authority to represent and to bind Fund Member, and the Fund will not be required to contact any other individual regarding matters arising from or related to this Agreement. Fund Member reserves the right to change its Program Coordinator as needed, by giving written notice to the Fund; such notice is not effective until received by the Fund.