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Please use this information to help you fill out the ID forms.
Form 20-211
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All lines must be completed
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Send completed forms to:
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Stephen Kohn
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23 Norman Lane
o
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Please fill in all personal information
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Also, please fill in the following
information:
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Line 7;
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second line; above Print Name; please
write-in Jayne Mayer
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second line; above Title;
Director Foundation
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Please fill in the following:
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Name of Employer’s Firm:
Verizon Pioneers
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Address of Firm:
23 Norman Lane, Darien, CT
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Telephone Number of Firm:
202 494 4160
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Last line of form;
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Title:
Executive Director – Verizon Pioneers · Applicant must either know that Verizon has their photo on file, or submit a
passport photo with the application for the ID pass.
Form 20-348
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Needs to be completed with each batch of
20-211s
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Please fill in the following:
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Manager’s Name:
Stephen Kohn; Title:
Ex. Dir. Vz Pioneers
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Originating Supervisor’s Name:
Jayne Mayer;
Title: Director
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Address:
295 N. Maple Ave, VC63S420, Basking
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Telephone Number:
(908) 559-6410
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Company;
Vz Foundation
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Department;
Foundation
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Please “check” the Issued box |
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