NAME CHANGE FORM

This form is for NAME CHANGE.

IMPORTANT: YOU MUST ALSO CONTACT THE BENEFITS OFFICE for instructions on what is needed for your medical and/or life insurance.

Previous Name Previous Name First Last
You must notify the SSA of your name change. The name on your tax return must match Social Security Administration records.
New Name New Name First Last
School or Building
Position
Certified Classified
Last 4 of Social Security #
Must be 4 characters. Currently Entered: 0 characters.
Previous Address Previous Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
New Address New Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Previous Phone Previous Phone - ### - ### ####
New Phone New Phone - ### - ### ####
Personal Email
Work Email
School District # of Residence

The school district number is required by law and can be obtained from a listing that is in each building or by calling the school district in which you reside.
Copy of New Social Security Card

Attach Files

Copy of SS card showing your new name or letter from SS office must be submitted with this form.
Copy of Marriage Certificate if Applicable

Attach Files
New W-4 and IT-4 Tax Forms
Tax forms can be found on The Treasurer's page .

Attach Files