Legal Name Change Request Form

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PLEASE NOTE: Submit this form for any name changes AFTER you have you have submitted your request to the Social Security Administration (SSA) office. Human Resources is unable to change names that have not been reported to the SSA office. Upon receipt of this form, your new name will be verified electronically through the SSA. If there are issues or discrepancies between what is requested and what the SSA office is reporting, you will be notified and the name change will be placed on hold.

If you have any questions, please contact Human Resources at 719-495-1100.

Email *

Have you submitted your name change request to the Social Security Administration (SSA) office? *

YES

NO (If your answer is "No", please fill out this form AFTER you have informed the SSA office.)

Employee ID Number (Found on your badge): *

Last four digits of your social security number: *

Former Legal Name (Last, First, Middle): *

New Legal First Name (as it appears on your Social Security card): *

New Legal Middle Name (as it appears on your Social Security card): *

New Legal Last Name (as it appears on your Social Security card): *

Thank you!

Your request will be processed during the first week of the month following your submission.

A copy of your responses will be emailed to the address you provided.

Submit

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