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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

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

Change Item(s)
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 by presenting your Social Security Card to the Human Resources office on the second floor of the Briegel Building for verification.

After this change is processed by Human Resources and Banner has been updated, HR will submit tickets to the Office of Information Technology Department requesting that your credentials be changed for Active Directory and SMC Wired and that a new Security Badge be issued which correctly reflects your new name. The Office of Information Technology staff will contact you to coordinate these changes.

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.

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.

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.

If you are an INDIANA resident please fill out your COUNTY for tax purposes.
Change of Phone Numbers
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.)

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.

Change of other personal information

Please update ONLY the fields which have changed.

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.
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