Telecom Request for Fund/Org Change

  • Authorization Information

  • Fund/Org Information Changes

  • Authorized Signatures

  • After submission, a PDF will be emailed to you. When you receive the PDF, please sign and date the below fields and return via fax (703-993-3541) or email (
    Forms will not be processed without physical signature.

    Signature of Current Fund/Org Telecom Coordinator Date
    Signature of New Fund/Org Telecom Coordinator
    (if different)
    Signature of OSP (if needed) Date