Enrollment Forms

Printable Benefit Enrollment Forms:

NOTE: You will need to download the forms and use Adobe PDF reader in order to fill out the forms electronically.

MEDICAL  

• Health Benefits Plan Enrollment Form

CASH IN LIEU - WAIVE SUSD MEDICAL

• Medical Coverage Waiver & Cash In Lieu Form
• Declaration of Health Coverage Form

DENTAL AND VISION

• Dental and Vision Insurance Enrollment Form

PARENT-CHILD RELATIONSHIP AFFIDAVIT

• Parent-Child Relationship Affidavit

Completed benefit enrollment forms may be scanned and emailed to:  Benefits@stocktonusd.net