Enrollment Forms
Enrollment Forms
Printable Benefit Enrollment Forms
Note: You will need to enter your name and email address when completeing the K12 enrollment forms.
Cash In Lieu – Waive SUSD Medical
Dental and Vision
Parent-Child Relationship Affidavit
K12 benefit enrollment forms are sent directly the the Benefits Analyst upon completion.
Eligible Dependents for SUSD Benefit Plans
- Spouse
- Registered Domestic Partner – current domestic partner registered with the California Secretary of State's Office.
- Domestic Partners: The cost of benefits for an enrolled domestic partner and children of the partnership is considered imputed income by the IRS. Imputed income is taxable and included in the employee's gross income, subject to federal tax withholding and payroll taxes.
- Children – includes natural born children, adopted children, stepchildren, and children of registered domestic partners.
- Parent-Child Relationship – children under age 26 for whom the employee has assumed parental status or duties, such as a grandchild, niece, or nephew.
- Disabled Children – children age 26 or older who have a mental or physical condition preventing them from supporting themselves.