EUOakland: Change of Status Request

Change of Status Request Form

Please answer all the fields marked with an asterisk(*). This information is necessary for continued EUOakland funding and will remain confidential.

Member Information:

*Why are you requesting a change in status?

I am returning to work permanently	*Start Date: / /
I am returning to work temporarily	*Start Date: / /
I am requesting a leave of absence	*Start Date: / /
	*End Date : / /
I plan to participate in EUOakland activities in the future, but for now please place me on inactive status.
I have stopped participating in EUOakland and do not plan to participate in the future.

Reason:

If you found permanent, part time, temporary or contract work,
please continue with the following questions:

*Title of new job:
*Name of new employer:
*City where you will be working: