21st Century Project - Department Liaison Add or Change Request

21st Century Project
Department Liaison

add or change request

Please complete the information below to assign or change your department liaison or back-up, as described in 21st Century Project Letter #04-007.

Department / Agency

DEPARTMENT LIAISON
Add New Department Liaison Change Existing Department Liaison
Liaison Name
Phone Number
Email Address

BACK-UP LIAISON
Add New Back-up Liaison Change Existing Back-up Liaison
Back-up Liaison Name
Phone Number
Email Address

LEVEL OF PARTICIPATION: Indicate below, the level in which your department is able to participate in the 21st Century Project. Department would like to participate in as many areas as is feasibly possible. Limited participation. Participation limited to surveys, etc. (no Focus Group discussions.) Unable to participate in any 21st Century Project activities at this time.

Provide any additional comments.