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Illinois Faith and Recovery Collaborative
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STATEWIDE ROSC COMMUNICATION Ticket
Please fill out the form for any changes with ROSC staffing.
Name:*
Lead Agency/Organization Name:*
Phone Number:*
Email Address:*
Mailing Address:*
ROSC Council Project Service Area (County/Community):*
This person is*:
New Staff
Replacing Staff
Update Contact Info
Remove Staff Name
If Replacing Staff, Write name of person that is being replaced:
Effective Date of Change*:
Other Information Needed:
Thank you! Your submission has been received!
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