Forms

Benefit Forms

Please see forms that are frequently used by the Benefits team. 

Adjunct Faculty Health Insurance Request Form
CalSTRS Recipient Designation Form

Medical Waiver Form
VEBA Medical Enrollment Form (internal use only)
Dental HMO Enrollment Form
Dental PPO Enrollment Form
FSA - TASC Enrollment Form
Metlife Legal Plan Enrollment Form
VSP - Vision Enrollment Form
Hartford - Voluntary Life Enrollment Form
Hartford - Voluntary Life Evidence of Insurability (EOI) Form