Name/Address/Phone Change Notification

This form is for Stockbridge Community Schools employees only. Please fill in the appropriate fields below.

You must submit updated State and Federal W4 forms and a copy of your new Social Security Card to Jennifer Goble before a name change can take effect.

The Business Office will update name changes with all Insurance carriers. It is the responsibility of the employee to update name changes with the Office of Retirement Services and VOYA directly.

Name

Name Change

Current Legal Name on Records

New Legal Name for Records

Address Change

Current Address on Records

New Address for Records

Phone Number Change

Current Phone Number on Records

New Phone Number for Records

Acknowledgements

I have submitted updated W4 forms to the business office Yes No

I have submitted a copy of my new Social Security card to the Business Office (only required for name change) Yes No

I have updated my information with ORS/VOYA Yes No

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