College of Arts, Humanities, and Social Sciences
User Separation Information
This section refers to person who is sending this form.
HSU Email (user name)
:
@
humboldt.edu
Last Name
:
First Name
:
Office Phone
:
ext:
The section below refers to the people who are
leaving.
First and Last names:
:
Theatre Arts Building 12 • 1 Harpst St., Arcata, CA 95521
(707) 826-4773 •
cahssitc@humboldt.edu
