REQUEST FOR EXCEPTION TO PUBLICATION
OF WORK-RELATED INFORMATION

After departmental approval, forward completed copy to Joanna Carey Smith, Associate University Counsel, CB #9105

1. EMPLOYEE INFORMATION
   I, _____________________________, ID # ________________ (ID # is required; PID for UNC-CH employees or SS # for UNC-Hospital employees) request that the work-related information checked below not be published in any campus directory for the 2007-2008 academic year:

   UNC-CH EMPLOYEES: THIS INFORMATION WILL NOT BE PROCESSED WITHOUT YOUR PID NUMBER.

   Please check the item(s) you want withheld:
   
_____ EMPLOYEE NAME:____________________________________________________

_____ WORKING TITLE/CLASSIFICATION TITLE:_______________________________

_____ CURRENT DEPARTMENT(s):____________________________________________

_____ WORK ADDRESS(es):_________________________________________________

_____ WORK PHONE(s):____________________________________________________

_____ WORK E-MAIL:______________________________________________________


2. EXPLANATION
   I request this exception for the following reason(s):
   
   
   
   

   Attach additional information if necessary.

3. APPROVAL
   A. Supervisory Approval
   This exception request is approved/not approved.
   
Supervisor: ____________________________

Date: __________________________________

   B. Legal Counsel Approval
   Your request for an exception has been reviewed, and is approved/not approved for the 2007-2008 academic year.
   
Associate University Counsel: ______________________________

Date: ______________________________________________________

You must renew your request for an exception for any future academic year.