Employee Change Request Form

The purpose of this form is to allow employees to submit changes to their personal data electronically. For example, this form can be used to report name and address changes or changes to emergency contact or degree information.

It is very important that your information be accurate as this information is used for multiple purposes including the employee directory.

Personal Information

First Name *

Middle Name *

Last Name *

SMC Phone Ext. *

Email Address *

Banner ID *

The fields above are pre-populated for you with information currently in the Banner system.

Change Item(s)

Type of Change *

Name change

Change of department, office location or title

Change of home address or other personal information

Change of phone numbers / Opt in for Emergency Text Messaging

Document additional education/degrees earned

Changes to Emergency Contact Information

Other

Please check all that apply.

Name Change Details

You will be required to present proof that your name has been changed on your Social Security Card before this change can be made. Please follow-up the submission of this request by presenting your Social Security Card to the Human Resources office on the second floor of the Briegel Building for verification.

New First Name *

New Middle Name *

New Last Name *

Change of department, office location or title

Please update ONLY the fields which are changed to indicate your new office location, department and/or title.

Primary Campus

Building

Department

Room No.

Official Title

Effective Date *

Month

Day

Year

Phone Extension

Please indicate below if you are moving a new location. The location of each phone is maintained in 911 systems for emergency purposes. These 911 systems will need to be updated so that the location of calls made from your phone can be accurately determined during an emergency. You will need the phone in your new location to be updated.

Moving to new location? *

SMC Phone Number

SMC Phone Number, part 1

SMC Phone Number, part 2

SMC Phone Number, part 3

Current Phone Extension *

New Location Phone

Since you indicated above that you are moving your phone to your new location, if you know, can you describe above what is happening to the phone that you are swapping out at your new location. For example, will the phone at your new location be moved to your old location? Please include the extension of the phone that is being swapped out.

Change of home address

Please update ONLY the fields which have changed or which have new information available that needs to be added.

Street

City

State

Zip Code

Change of Phone Numbers

Home Phone

Home Phone, part 1

Home Phone, part 2

Home Phone, part 3

Cell Phone

Cell Phone, part 1

Cell Phone, part 2

Cell Phone, part 3

Outside Work Phone

Outside Work Phone, part 1

Outside Work Phone, part 2

Outside Work Phone, part 3

Unlisted Number(s)?

Yes

Optional Text Messaging Preference

Southwestern Michigan College utilizes the Rave Mobile Security system to inform students and employees about school closings, weather alerts and other important information.

The Rave system has already been configured to automatically send out notifications to:

your SMC email account
your primary phone number on file
your cell phone number on file

If you would like to confirm what contact information is currently "on file" for you, click here to visit the Personal Information area of SMC Self Service.

If you need changes to any of the phone numbers on file, simply check the Change of phone numbers<.em> above.

In addition, and only with your consent, the Rave system is also capable of sending you a text message delivered right to your mobile phone.

(Please note that your phone must be capable of receiving text messages and that certain charges may be applied to your phone bill depending on your wireless carrier.)

Optional SMS (Text Messaging) *

In order to deliver text messages to you, we must have your cell phone number on file with Southwestern Michigan College. Please complete Cell Phone field above before submitting this form.

Describe Other *

Change of other personal information

Please update ONLY the fields which have changed.

Saluation

Nickname

Maiden Name

U.S. Citizen

Marital Status

Handicapped?

Document additional education/degrees earned

You are required to submit your a transcript as proof that you have earned each of the degrees listed. Please send your transcript(s) to the Human Resources Department.

1 Degree Earned *

1 Institution *

1 Major *

1 Date *

Month

Day

Year

Second Degree to Report? *

2 Degree Earned *

2 Institution *

2 Major *

2 Date *

Month

Day

Year

Third Degree to Report? *

3 Degree Earned *

3 Institution *

3 Major *

3 Date *

Month

Day

Year

Fourth Degree to Report? *

4 Degree Earned *

4 Institution *

4 Major *

4 Date *

Month

Day

Year

Emergency Contact Information

You can make these changes yourself. Simply go to into SMC Self-Service > Personal Information > Update Emergency Contacts. There is no need to submit this form.

Additional Comments/Instructions

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Employee Change Request Form