Enrollment/ Changes Form and List of Acceptable Supplemental Dependent Documentation
- Enrollment and Changes Form
- Acceptable Supplemental Dependent Documents Guideline
- SS # Form (ex. Used for newborns if an enrollment/ changes form was already submitted and SS # was received later on)
- If you are adding dependents to your coverage, we can accept copies of documents. Per board policy (1340), if you bring in an original document without a copy, we can make a copy for $0.25 per page (cash only).
- Please send completed documents containing sensitive information to our department via fax, district mail, US mail, or in person (not via email).
- ***If you are trying to submit documents to make changes to your coverage outside of Open Enrollment, please reference the tab on our homepage labeled, 'Qualifying Life Events', for more information.
