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Forms > Employee Data Form

Some of the information requested below is provided to the University System of Maryland and other State and Federal agencies as required by law. Data supplied to the USM offices is of a statistical nature only, with no direct reference to you. Please complete this form in full, and submit when complete.

Fields marked by * are required.

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Contact Information
First Name*
Middle Initial*
Last Name*
Title (prefix)*
Address (Number and Street)*
City*
State*
Zip*
County of Residence*
Home Telephone*
E-mail Address*
Personal Information
Date of Birth*
Gender*
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  •  
Marital Status*
Are you of Hispanic or Latino origin?*
  •  
  •  
Race*
Military Status*
Highest Level of Education*
Highest Level Degree Code
Highest Level Degree Type
(i.e. Bachelor's, Master's, Doctor's)
Visa Status (if Non-US Citizen) Visa Code
Emergency Contact Information
First Name
Last Name
Telephone