Benefits Forms
Note: Please contact benefits@foundation.sdsu.edu if you need assistance obtaining any form. Completed forms can be submitted to Human Resources by FAX: (619) 594-3763.
Health and Dental Forms
- Benefits Enrollment / Change/Decline Form (PDF Format, 590 KB)**
- Kaiser HIPAA Release (PDF Format, 79KB)**
- Health Net HIPAA Release (PDF Format 59KB)**
Flexible Spending Accounts (FSA) Forms
- Flexible Spending Accounts Section of Benefits Enrollment/Change/Decline Form (PDF Format, 590 KB)**
- Salary Reduction Agreement Form (Word Format, 402KB)**
- TIAA-CREF Designation of Beneficiary Form (PDF Format, 381KB)**
Domestic Partner Forms
- SDSURF Declaration of Domestic Partnership Form (PDF Format, 30KB)**
- SDSURF Domestic Partner Tax Dependency Certification Form (Word Format, 398KB)**
- State of California Declaration of Domestic Partnership Form (PDF Format, 153KB)**
- State of California Domestic Partnership Termination Notice (PDF Format, 185KB)**
General Forms
- Address Change Form (Word Format, 394KB)**
- Hartford Supplemental Life and Voluntary AD&D Enrollment Form (PDF Format 93KB)**
- Name Change Form (Word Format, 396KB)**
You must present new Social Security card with new name to Human Resources Representative. - Payroll Direct Deposit Enroll/Cancel Form (PDF Format, 358 KB)**
**This document may not be accessible to machine-reading devices, if you are experiencing difficulties accessing this information please contact HR at 619-594-4139.
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DISCLAIMER
Every effort has been made to ensure the accuracy of the benefits information in this site. However, if any provision on the benefits plans is unclear or ambiguous, Human Resources reserves the right to interpret the plan and resolve the problem. If any inconsistency exists between this site and the written plans or contracts, the actual provisions of each benefit plan will govern. The provisions of the plans are subject to change.