Skip redundant pieces
Institutional Finance & Administration
KUMC  :  Institutional Finance & Administration  :  Payroll  :  Name Change
Payroll

The University of Kansas Medical Center and Affiliates Employee Name/Address Change Form

Red fields are required (form will not be sent if no information is entered in these fields).

Are you a KUMC employee? Yes    No ___
   
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 remember do not close your bank account(s) until after you receive your last paycheck.

 
Current Name: (last, first, mi)
Current Preferred Name:
Employee's Last 4 digits of Social Security Number:  
Employee's Email Address:
 
 
 
NAME CHANGE
New Name:  (last, first, mi)

NOTE: You must provide an updated social security card for verification of name change either in person (Suite 120, Support Services Facility) or by FAX to (913) 588-5228.
 
New Preferred Name:
 
 
 
NEW ADDRESS
Street:
City: State: Zip Code:
County in Which You Reside: Country:  
 
Home Phone Number: (ex: 913/642-5555)
Work Phone Number:

If you have any questions about completing this form call ext. 8-5100.