Name, phone and E-mail address of person entering this data
IF other than the person named below:

Name of new staff or staff to make changes to:

Directory Title:
4-H Regional Extension Educator
4-H Program Coordinator
4-H Program Director
4-H Regional Support Staff
County Support Staff
Other (please indicate below)

Working Title:

County(ies) of responsibility (if applicable):

Work location (xxx County Office, xxx Regional Center, etc.):

Work contact information that differs from work location contact
info (i.e. cell phone, direct phone number, etc.):

Work Supervisor:

Percent Time Working (FTE - Full Time Equivelants):

Source of funds for position
(U of MN, county, grant, etc.)

Official starting date (if applicable):

Education (degree(s) earned, institution, emphasis, discipline, etc.):

Home contact information
(address, phone, person to contact in an emergency, etc.):

Birthdate (optional):