METROPOLITAN STATE UNIVERSITY OF DENVER
ADDRESS/NAME CHANGE FORM
900# Name:
Name Change
Address Change
Effective Date Effective Date
*IF YOU ARE REQUESTING A NAME CHANGE, YOU MUST PROVIDE A COPY OF YOUR UPDATED SOCIAL
SECURITY CARD.
Part-Time Faculty
Full-Time Faculty
Classified
Administrator
Student
Other
______________
NEW INFORMATION
Name
Address
City
State
Zip
Telephone
E-Mail Address @msudenver.edu
PLEASE SEND THIS COMPLETED FORM AND ANY REQUIRED ATTACHMENTS TO HUMAN
RESOURCES CAMPUS BOX 47 OR BY FAX TO 6-5151
Please contact your retirement company directly to obtain additional forms for your name/address
change that they may require.
1-800-842-2009
1-800-343-0860
1-800-448-2542
303-832-9550
__________________________________________________________________________________________
HR use only
Sent confirmation email Anthem NAME CHANGES ONLY
Banner change VSP Notified payroll/rep
Flex Spending Benefit Solver I9 update
Please note: You will receive a confirmation email once your information has been updated.