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Update Personal Information (University of Texas System)

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PAGE 1 of 1 REVISED 9/2019
Update Personal Information
MEMBER INFORMATION
Last Name First Name Middle Name
Employee ID/Benefits ID (BID) Street Address
Apt., Floor, Unit, etc. City State Zip Code
Home Phone (XXX) XXX-XXXX Email Address
Cell Phone (XXX) XXX-XXXX Would you like to be contected by email? Yes o No o
EMERGENCY CONTACT #1
Name Email Relationship
Home Phone (XXX) XXX-XXXX Street Address
Cell Phone (XXX) XXX-XXXX City State Zip Code
EMERGENCY CONTACT #2
Name Email Relationship
Home Phone (XXX) XXX-XXXX Street Address
Cell Phone (XXX) XXX-XXXX City State Zip Code
210 W. 17
th
Street, Austin, Texas 78701 | Fax (512)499-4338 | Phone (855) 688-2455
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Completed 13 January 2021

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