University-wide Navigation
  • Life Insurance and AD&D 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 additional life insurance coverage for yourself, spouse/sponsored dependent, or children. Qualifying dependent children may be covered to age 26.  This form also allows you to enroll in separate accidental death & dismemberment insurance.  

  • Revision date: