REQUEST FOR PRIMARY NAME CHANGE
Employee ID __________________
Department _______________________________________
New Name _____________________________________________________
New Name must match Social Security Card Visual Verification Required
Name currently on file with Boise State
Diploma Name_______________________________________________________
I request that my name be changed in official University employment records
_____________________________________________ ________________
Signature Date
Payroll use only
Peoplesoft ___________ IPOPS_______________Email___________________
3/10/17