How can we help you?

** Required fields are highlighted and preceded by an asterisk

*Subject:

Select a category
*Category
  Subcategory
*Unit

Contact Information
*Last Name
*First Name
Middle Name
Employee #
Department
Job Title
*Phone Number
Cell Phone Number
*Email Address

Note
  

Click the "Submit Issue" button to send your Request.

Be sure to click the submit button only once. A separate Issue will be entered each time the button is clicked.

You will receive email updates from "PASSHE Support" as your request moves through the process. Please email Human Resources or call 610-683-1353 if you experience problems using this form.