Employee Name
Department
Email
Retype Email
Gender Male Female
Have you recently had a name change? Yes No
PLEASE NOTE: If name change is applicable, please submit documentation to the CSU Human Resources Department. Name changes submitted without proper documentation will not be processed You may attach your official documentation here (MSWord or PDF only):
Permanent/Physical Address:
City
State
Zip
Mailing Address:
Home Phone
Alternative Phone
Change of Address or Name Change of Address or Name