2016 Employee Enrollment/Change Form - save the form to be able to view all pages
Premium Payment Plan Election/Change
Valid Dependent Verification Documents - dependent verification documents are required if adding a spouse/state-registered domestic partner and/or children. Please see below for more information.
Additional forms you may need are linked in the categories below.
Dependents - Spouse and Children
Dependent Eligibility Worksheet - This worksheet includes details on who is eligible to be covered on an employees plan as a "dependent," as well as a list of valid dependent verification documents. For extended dependents and dependents with disabilities, please see below.
Domestic Partnerships
If enrolling an eligible domestic partner, you must also register your partnership. If you need to register with the State of Washington, please go to the Washington Secretary of State website.
Forms
Declaration of Tax Status
Extended Dependents and Dependents with Disabilities
Certification of Dependents with Disabilities
Extended Dependent Certification
Flexible Spending Account (FSA) and Dependent Care Assistance Program (DCAP)
Health Savings Account (HSA)
Public Employees Retirement Plan (PERS)/Teachers Retirement Plan (TRS)
Member Information Form (for Civil Service, Bargaining Unit and Hourly)
Retirement Participation Election Form ( for Faculty and Administrative Professional)
Higher Education Employees Plan 3 Investment Program Form (for Faculty and Administrative Professional)
Beneficiary Designation
Plan 3 Change of Investment Program: Choose between the Washington State Investment Board (WSIB) and the Self-Directed Investment Programs.
Name & Address Change : To be completed by inactive members, retirees and beneficiaries receiving benefits. Active members update your address through MyWSU account.
VEBA Enrollment Form
Washington State University Retirement Plan (WSURP), TIAA-CREF
Retirement Participation Election Form How To Enroll Online Guide 10% Increased Contribution: At any time following your 50th birthday you may elect to increase your contribution rate to 10%.
Paper Enrollment Form: Use this form to enroll by mail. Use the How to Enroll Online Guide above to enroll online.
VEBA Enrollment Form Change of Name: Use this form to update your name on your retirement account. Return completed form to address noted on top of form.
Beneficiary Change via TIAA-CREF website: Use this link to update your beneficiaries on your retirement account.
Beneficiary Change Form: Use this form to update your beneficiaries on your retirement account.
Voluntary Investment Plans
2016 Salary Reduction Agreement : Use this form to designate your desired contribution for the TIAA-CREF Voluntary Investment Plan.
Deferred Compensation Participation Agreement: Use this form to designate your desired contribution for the Deferred Compensation Program (DCP).
