Name & Address Change Checklist

Below is a list of forms that classified and certified employees are required to complete for a name change or change of address. An employee that is changing their name is also required to provide a copy of their new social security card and a copy of their marriage license or divorce decree. Classified employees should submit their information to Patricia Brezina in Human Resources and certified employees should submit their information to Nicole Brenczenwski in Human Resources.

Name Change Forms for Classified Employees

• IMRF Member Information Change Form
• W-4 Form
• Group Health & Dental Insurance Enrollment Form
  This form should only be completed by employees who have district insurance
• Sun Life Beneficiary Form
  This form should only be completed by employees who have district insurance

Change of Address Forms for Classified Employees

• IMRF Member Information Change Form
• Health and Dental Insurance Address Change Form

Name Change Forms for Certified Employees

• TRS Member Information and Beneficiary Designation Form
• W-4 Form
• Group Health & Dental Insurance Enrollment Form
  This form should only be completed by employees who have district insurance
• Sun Life Beneficiary Form
  This form should only be completed by employees who have district insurance

Change of Address Forms for Certified Employees

• TRS Change of Address Form
• Health and Dental Insurance Address Change Form