Address, Phone Number and Email Change for Former Employees or Surviving Spouse/Partner

Purpose

This form allows an address, phone number and email change to be made for former employees or surviving spouses/partners.

Former Employees: Return this completed form to Employee Services.

Former Student Employees: Address changes must be made both in the Student Information System (SIS) and the payroll system.

Last updated: 5/31/2017

Download this form below. Then save a copy to your computer, open it in your PDF reader and fill it out electronically.