Forms → Staff → Benefits → Change in Personal Information for MCPS Employees
Form number: 445-1A
Audience: MCPS Staff, School Staff, MCAAP Members, MCBOA Members, MCEA Members, SEIU Members, MCCSSE Members
Last revised: November 2019
INSTRUCTIONS: Please type or print. Use this form to change or correct your name, title, date of birth, and/or Social Security number (only after receipt of your new official Social Security card). (Address and telephone number changes must be made via the Employee Self-Service (ESS) web page.
Complete this form, sign, and return it to the Employee and Retiree Service Center (ERSC). You may fax the form to 301-279-3642/301-279-3651 or e-mail an electronically signed Adobe PDF file to ERSC@mcpsmd.org.
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