State Phone Directory Form for MDH

State Phone Directory Form for MDH

Use the form below to submit a request to add a new employee, make a change to existing information, or to delete information from the State Telephone Directory.

If you are submitting multiple employees, please use the file upload option at the bottom of the form. Be sure the attachment includes all the information listed on the request form.

If you need assistance completing the form, please contact Michele Marable at 410-767-6863. Thank you.

Type of Request:*

Select or enter value

If the new employee is replacing a former employee that needs to be removed from the directory, please list the name.

New Employee Name:*

Former Employee Name:*

Title/Classification:*

Administration:*

Office:*

Unit:*

Address:*

Telephone Number:*

Email Address:*

File Attachments:

Drag and drop files here or

Send me a copy of my responses

Privacy Notice|Report Abuse