Active Employees Address/Name Change

Active Employee Change of Address or Name

Complete this form for any Name or Home Address change. Proof of name change must be sent to Office of Human Resources. Please note that you must also change your address with your Lafayette College retirement account provider(s): • TIAA at 1-800-842-2252 • Fidelity customer support at 1-800-343-0860

Name(Required)

First Last

Lafayette netid(Required)

Please provide your Lafayette email

Are you Faculty?(Required)

Yes

Previous Name

You must provide proof of name change to Human Resources before any changes are made. If you would like an email change as a result of your name change, you must submit a ticket to the help desk.

First Last

New Address

Street Address Address Line 2 City State ZIP Code

New Cellphone

New Home Phone

Effective Date of Change(Required)