________________________________________________________________________ ____________________________
_____________________________________________________
Change of Address and/or Telephone Number
Please Print
HR Use Only:
Date Entered & Initial
Last Name First Name MI ID# or Social Security #
Please change my address and/or telephone number in all human resources, payroll,
retirement and insurance records (if applicable) to:
Address ______________________________________________________
Telephone# (_______) _____________________________
Type of Employee: (Check One)
_____ Academic (Full or Part Time Faculty, including Librarians with Faculty Status)
_____ Administrative Professional Staff (Unclassified Full or Part Time)
_____ Civil Service or Seasonal Staff
_____ Student Workers
Signature ____________________________________________ Date: _____________________________
NOTE: Your W-2 Form is sent to the latest address on file in the Office of Human
Resources/Payroll. It is especially important to provide a forwarding address when
leaving the College.
If this form is returned from off campus, please mail to:
Sowela Technical Community
College, Office of Human Resources, P. O. Box 26950, Lake Charles, LA 70616-6950. You may
contact the Office of Human Resources at 337.491.2699 if you have any questions.
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