Personal Data Change Form

Complete the form below, or use this printable form, to update your marital status, education, or name. Get more information on the Changing My Benefits page.

Changes to home address, phone number, emergency contact(s), and self-identification data can be updated in HRMS by navigating to Self Service > Personal Information > Personal Information Summary. If you do not have access to a computer, please call ASK URHR (275-8747) for assistance.

Name: Currently in records * Required
First Last
Employee ID * Required
Phone Number
Email Address
Reason for Completing the Form * Required
- Name Change
- Marital Status Change
- Education Change
Please select all that apply.
Highest Education
Marital Status
Name of Spouse * Required
Effective Date of Marital Status Change * Required
MM slash DD slash YYYY
Spouse's Gender
As a result of my marital status change, my domestic partner is now my spouse.
Name Change: New Name
First Last
Upload supporting documentation * Required
Drop files here or

Accepted file types: pdf, jpg, jpeg, Max. file size: 20 MB.
All name changes require proof provided to HR Administrative Services. Please upload documents such as a copy of a marriage certificate, divorce decree, driver’s license, or Social Security card with the new name. If changing Marital Status, you may also want to consider completing a new W4 and IT-2104.
Signature * Required
- I acknowledge that providing my electronic approval is equivalent to signing the document and I understand that my electronic signature is binding.
Date * Required
MM slash DD slash YYYY