Human Resources Department

KU School of Medicine-Wichita
Employee Name/Address Change Form

All fields are required
(You must fill out all fields whether you are doing a name or address change. The form will not send if required fields are left blank).

Are you? Classified or Unclassified Faculty

Is This a Name Change, Address Change or Both?
 Name Change Address Change Both

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


Employee's email address:


Name Change

New Name: (last, first, mi)


NOTE: You must provide an updated Social Security card for verification of name changes to Human resources, room 2022.

New Address

Street:
City:
 State:
 Zip Code:

County in which you reside:

Home Phone Number: (ex: 316/688-5555)


Work Phone Number:


For questions call 3-2615.

 

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