Staff Name Change

*Please note, required fields are in red.

Please complete the form below. In addition, please send a copy of your Social Security Card and current license with your new name to the Personnel Office. Once Personnel receives the appropriate documentation your name will be changed in the system.
CURRENT Last name, First name
NEW Last name, First name
	Send me a copy?
	CAPTCHA entry Required Invalid CAPTCHA Code

Please complete the form below.