Address Change & Other Contact Information Updates

 Use this form to make updates or changes to your contact information including address changes, phone number updates, and emergency contact information.


PLEASE NOTE: Student workers also have to change their address with Admissions & Records for student records.  Click here to update your address with A&R. You can also email

What would you like to update? (check all that apply)*
Personal information that needs updated*
Preferred Name*
Pronoun Identifier

Personal Contact Information Update

New Address*
Which phone number are you updating? (check all that apply)*
For "Other," please specify type of # and note phone # in the space provided.
Are you represented by the AFT, ECCE, or POA union?*
Do you want your updated phone number released to your union?*

Emergency Contact (in case of accident or serious illness)

Name of Emergency Contact*
(Example: spouse, parent, sibling, neighbor, etc.)
Address (if known)
Would you like to add a secondary emergency contact in the event that the District is unable to reach your primary emergency contact? *
Name of Emergency Contact #2*
(Example: spouse, parent, sibling, neighbor, etc.)
Address (if known)

Personal Physician's Contact Information

Physician's Name*

Hospital of Choice (if unable to reach physician)

Name of Hospital - include address, city, state, zip

Authorization Signature

Updates will become effective as soon as they are processed by Human Resources. This can take from 1 to 5 work days. If you would like updates/changes to take effect for a future date, please provide specific instructions in the text box above.

Use your mouse or finger to draw your signature above


Date Processed*
Check box if updated in these systems*