KU School of Medicine-Wichita
Employee Name Change Form

Note: You must submit a copy of your new, signed social security card reflecting your official name change to Human Resources before this request can be processed

All fields are required
(You must fill out all fields. The form will not send if required fields are left blank).

Are you? Classified or Unclassified Faculty

Employee's Name: (last, first, mi)


Employee's email address:

Name Change

New Name: (last, first, mi)

For questions call 3-2615.