Villanova University
Employee Personal Information Change Form
When making an address change, you must complete the PA Residency Certification form, available on the Payroll Department's
website here. This form must be completed by all employees regardless of their state of residency. If you have any questions
regarding the form or instructions, please contact the Payroll Department.
Employee Name:
Department:
Effective date of change:
Update Address and/or Phone Information:
Street Address:
City, State Zip:
Home telephone #:
Cell Phone #:
Update Emergency Contact Information:
#1-Contact Name:
Relationship:
Address, City, State, Zip:
Phone #1:
Phone #2:
#2-Contact Name:
Relationship:
Address, City, State, Zip:
Phone #1:
Phone #2:
Update Personal Information:
Change in Visa/Residency/Citizenship Status to:
Add Permanent Residency number:
Change in Marital Status to:
Update Veteran’s Status Information:
_______________________________________________
Signature
____________________________
Date