Benefits Enrollment/Change Form for Classified Staff

Purpose

 This form allows classified staff to either enroll in a benefits program or change a current benefits program.

NOTE: Any necessary paperwork and documentation must be submitted within 31 days of your date of eligibility or qualifying life event and by the 10th of the month in order to start on that month's paycheck.

Last updated: 4/20/2020

Download a form below and open in Adobe Acrobat. Forms can be submitted electronically or printed and mailed/faxed to Employee Services.