• Dental Care Services
• Hearing Aids
• Orthodontic Pre-Authorization
• Prescription
• Vision Care Services
• Prescription Copayment HRA Opt-In

 Scholarship and Tuition Assistance Forms

•    Scholarship Award Application
•    Teacher Appraisal
•    Tuition Assistance Application for Participant
•    Tuition Assistance Application for Child of Participant

 

 Address Change

         Address Change 

 

Pension Forms

• Pension Credit Form (English)
• Pension Credit Form (Spanish)

 

• Authorization for Electronic Deposit

 

Enrollment and Payroll Deduction Forms

• Silver, Gold, Platinum Plan A
  • Enrollment Form – Clerk's Helpers
  • Enrollment Form – Less Than Two Years of Employment
  • Enrollment Form – Two Years or More of Employment
  • Payroll Deduction Authorization – Clerk's Helpers
  • Payroll Deduction Authorization – Less Than Two Years of Employment
  • Payroll Deduction Authorization – Two Years or More of Employment

 

• Silver, Gold, Platinum Plan B
  • Enrollment Form – Utility Clerks
  • Enrollment Form – Less Than Two Years of Employment
  • Enrollment Form – Two or More Years of Employment
  • Payroll Deduction Authorization – Utility Clerks
  • Payroll Deduction Authorization – Less Than Two Years of Employment
  • Payroll Deduction Authorization – Two Years or More of Employment

 

• Platinum Plus Plan A
•             Enrollment Form

 

• Platinum Plus Plan B
•             Enrollment Form