Fridley Public Schools - Name, Address or Telephone Number Change
Name, Address or Telephone Number Change
Organization:
Fridley Public Schools
Assigned To:
Public User
Show History
Name, Address or Telephone Number Change
Please fill out this form if your name, address or telephone number changes.
Please note: Technology, payroll, and your school will be informed of the change. (if you provide your building/program secretary's email address below).
Name changes require legal documentation
. Please present documentation in person to Human Resources in the district office. Examples of acceptable documentation are: updated driver's license or social security card, official marriage certificate, divorce decree. Name Changes also
require
that you send a signed W-4 form to Krysta Landry through the interoffice mail. W-4 forms are available on the Fridley School District website under Employment/Employee Resources.
Reminder to Teachers:
You are also
required
to change your name on your teaching license at MDE.
You must also change your demographic information with Plansource (https://benefits.plansource.com/logon) our insurance administrator. If you have flex accounts or a VEBA, you also need to change your address with Further at www.hellofurther.com
NAME (First and Last)
BUILDING:
DISTRICT OFFICE
FRIDLEY COMMUNITY CENTER
FRIDLEY HIGH SCHOOL
FRIDLEY MIDDLE SCHOOL
ALC-HS
ALC-MS
ECSE
HAYES ELEMENTARY
RL STEVENSON ELEMENTARY
TRANSITION
POSITION:
Your BUILDING/PROGRAM SECRETARY'S email (not your email)
EMPLOYEE NAME CHANGE:
NEW NAME (Include First and Last Name):
EFFECTIVE DATE OF NAME CHANGE:
EMPLOYEE ADDRESS OR PHONE CHANGE
NEW ADDRESS (Include House Number, Street Address, City, State & Zip)
NEW PHONE NUMBER (Include area code)
EFFECTIVE DATE OF ADDRESS/PHONE CHANGE:
NEW EMAIL ADDRESS:
COMMENTS: (use this box to let us know if there are other changes to your demographic information needed in skyward, i.e. update an emergency contact, delete a phone number, add another email address, etc.)
EMPLOYEE SIGNATURE
Signing
Signature is required
For HR Use: Update Teachers on Call with NAME CHANGES
Yes
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History
Step:
Someone fills out the form
Sent To: Public User, On:
3/27/2023 9:01:45 AM Central Standard Time
