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Completion Instructions for Change of Address/Telephone Number Form

Please follow these instructions for completing your Change of Address/Telephone number. If you have questions about completing the form, check with your supervisor or Human Resources office for assistance.


  1. Write in the effective date of change to information. Example: 02-01-2003
  2. Write in your EMPLID. This is the unique 8 digit number used to identify each employee.
  3. Write in your name (last, first, middle) as it appears on your social security card.
    • Example: Smith,Delores J
  4. Check (X) the box that indicates how you prefer to be addressed.
  5. Write in the address where you currently reside. For students living on campus, this address will be a residence hall.
  6. Write in your home telephone number, including area code. Example (573) 555-0000
    • Write in your University work telephone number, including area code and check whether you are on or off campus. Example: (573) 882-0000
  7. Mailing Address: Provide a mailing address if you want to receive mail at an address other than where you currently reside. If you provide a mailing address, it will be used for mailing your W-2.
  8. Complete UM Work Address: Provide either an on campus work address or an off campus work address but not both.
  9. Sign Your Name and Date: Check if you want to restrict the release of your home address and home telephone number i.e., it will not be released unless required by law or University policy.

Reviewed 2019-08-05