Forms
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- Retirement Notice to Benefits (Web Form)
- Benefits Enrollment Worksheet (OnBase/PolyDoc Form)
- Declaration of Health Coverage (PDF)
- Affidavit of Parent-Child Relationship (PDF)
- Affidavit of Marriage/Domestic Partnership (PDF)
- CalPERS Request for Service Credit Information - Military Leave of Absence Service (PERS-MDS-369A) Form - This form is for new employees and those returning from a military leave to purchase their active duty military service credit through CalPERS.
- Covered California Notice (PDF)
- CSU Privacy Notice (PDF)
- Flexible Spending Account (FSA) Debit Card Request Form (Optional for HCRA Plan Participants)
- HCRA/DCRA Manual Claim Form (PDF)
- The Standard’s Enrollment and Change Form (PDF)
- VSP Out-of-Network Reimbursement Form (PDF)
- VSP Vision Care Premier Enrollment (PDF)
- VSP Computer Vision Glasses Conformation Form (PDF)
- e-Benefits Electronic Signature Authorization (OnBase/PolyDoc Form)
COVID-19 CSU Temporary Paid Administrative Leaves
- Families First Coronavirus Response Act Request (FFCRA) (Docusign)
- Coronavirus Paid Administrative Leave Request (CPAL) (Docusign)