1. Delgado Community College
  2. Change of Address/Name Form
    1. Employee: ______________________________________________________________
    2. Social Security Number: ________________________________ Date: ____________
    3. New Telephone Number: __________________________________________________
    4. New Name: _____________________________________________________________
    5. Please Read
    6. Please select a link below for the other forms
      1. LASERS Change of Address Form, OGB Enrollment/Change Form,
      2. TRSL Enrollment Application/Notification Form, TRSL Name Change Request Form

Delgado Community College

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Change of Address/Name Form

 


Employee: ______________________________________________________________

 


Social Security Number: ________________________________ Date: ____________

 

 

New Home Address:

 
 

   

 

 

New Mailing Address:

(If different from Home Address )

 
 

   

 

 

 


New Telephone Number: __________________________________________________

 

 


New Name: _____________________________________________________________

 

*** A COPY OF A SOCIAL SECURITY CARD WITH THE NEW NAME IS REQUIRED FOR A CHANGE OF NAME.


Please Read

 

THIS FORM CHANGES AN EMPLOYEE’S ADDRESS AND NAME INTERNALLY ONLY. IT IS THE EMPLOYEE’S RESPONSIBILITY TO CHANGE HIS/HER ADDRESS AND/OR NAME WITH THEIR MEDICAL INSURANCE, RETIREMENT, OPTIONAL RETIREMENT PLAN, ETC. ***


Please select a link below for the other forms

 


LASERS Change of Address Form , OGB Enrollment/Change Form ,


TRSL Enrollment Application/Notification Form , TRSL Name Change Request Form

 

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Return to:  Human Resources Department  HRD 12/2010

 O’Keefe Admin Bldg 37, Pod A  DCC 2030/001

 Phone: 504-762-3015 Fax: (504) 361-6686