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Human Resources >
Employee Resources >
Name or Address Change Form
* * * ATTENTION! This form will not be sent if fields are left blank in this section. *** *** This form is for University Employees only - Hospital or KUPI employees contact your HR Dept ***
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:
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 CorrectionMovedNo longer an employee* *If you select this option, please do not close your bank account(s) until after you receive your last paycheck.
Select Your State
County in Which You Reside:
Home Phone Number: (ex: 913-642-5555)
If you have any questions about completing this form, contact Erica Rogers at 913-588-5099.