Name Change Form

For name changes, complete and submit this online form and then report to the Office of Human Resources within 7 days to present your new Social Security card as proof of the name change. A photo or copy will not be accepted.

*Reason for Name Change:

*CWID:

*Prior First Name:

Prior Middle Name:

*Prior Last Name:

*New First Name:

New Middle Name:

*New Last Name:

Employee Type:

Permanent

Temporary

Student

Notes:

Students must present name change information with the office of Records & Registration
Update existing I-9 in the office of Human Resources when changing your name
PEBA insurance and retirement will be notified of the change by HR as needed