KUMC Employee Name or Address Change Form

* * * ATTENTION! This form will not be sent if fields are left blank in this section. * * *

Are you a KUMC university employee? Yes No

Current Name: (last, first, mi)

Employee's Last 4 digits of Social Security Number:

Work Phone Number:

Employee's Email Address:

Current Name: (last, first, mi)

New Name: (last, first, mi)

NOTE: You must provide an updated social security card for verification of name change in person to Employment (1044 Delp) to have your signed Social Security Card scanned.

If you are requesting an address change, why are you doing so?
Address Correction
Moved
No longer an employee*
      *If you select this option, please do not close your bank account(s) until after you receive your last paycheck.

Street:

City: State: Select Your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Zip Code:

County in Which You Reside:

Country:

Home Phone Number: (ex: 913-642-5555)