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  • Flexible Spending Account Enrollment Form 2023-24
  • Click to view (pdf or doc)
  • Plan year July 1, 2023 through June 30, 2024 Use this form to enroll in health and/or dependent care flexible spending accounts (FSA). You must download the form and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.  
  • Revision date: 04/13/2023
  • Submit paper form to Benefits Office, 112 Scovell Hall, Lexington KY 40506-0064
  • Email form back to