Staff Address & Name Change Form

1.	Legal first name (before name change)*

2.	Legal last name (before name change)*

3.	Employee type*
	Employee type* Certificated Classified Administration Substitute

4.	Work email address*

5.	Location*
	--Please Select--AIM High SchoolCascade View ElementaryCathcart ElementaryCentennial Middle SchoolCentral Primary CenterDutch Hill ElementaryEmerson ElementaryGlacier Peak High SchoolLittle Cedars ElementaryMachias ElementaryOperations and MaintenanceParent Partnership ProgramRiverview ElementaryResource and Service CenterSeattle Hill ElementarySnohomish High SchoolTotem Falls ElementaryTransportationValley View Middle School

6.	What are you changing?*
	What are you changing?* Residence address (see question 7) Mailing address (see question 8) Phone number (see question 9) Name (see questions 10-13)

7.	New residence address
	Street   City   State   Zip code   Phone number   Is this your mailing address? New residence address             --Please Select--YesNo

8.	New mailing address
	Street   City   State   Zip code New mailing address

9.	New phone number
	Home phone (including area code)   Cell phone (including area code) New phone number

10.	New name (person 1)
	Family member(s) or student(s) currently at Snohomish School District   First name   Last name   Employee or student New name   --Please Select--YesNo       --Please Select--EmployeeStudent

11.	New name (person 2)
	Family member(s) or student(s) currently at Snohomish School District   First name   Last name   Employee or student New name   --Please Select--YesNo       --Please Select--EmployeeStudent

12.	New name (person 3)
	Family member(s) or student(s) currently at Snohomish School District   First name   Last name   Employee or student New name   --Please Select--YesNo       --Please Select--EmployeeStudent

13.	New name (person 4)
	Family member(s) or student(s) currently at Snohomish School District   First name   Last name   Employee or student New name   --Please Select--YesNo       --Please Select--EmployeeStudent

	This form can only be filled out and submitted by the person above, if you are this person you can submit. If you are not this person you must leave this page immediately. By clicking "Done", you are confirming that you are the person noted above, and that you want this form submitted.