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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 go to Employment to have your signed Social Security Card scanned.
 
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.