Holiday closure: Employee Services will be closed Monday, Jan. 20, in honor of Martin Luther King, Jr. Day. We will reopen at 8 a.m. Tuesday, Jan. 21.
Benefits Enrollment/Change Form for Retirees
Purpose
This form allows for retirees to either enroll in a benefits program or change their current benefits enrollment program.
NOTE: This form must be submitted within 31 days of your date of eligibility or qualifying life event.
Last updated: 9/2024
