FORMS REQUIRED FOR those continuing coverage IN THE ASSOCIATE FACULTY MEDICAL BENEFITS PROGRAM

• Declaration of Eligibility Form to continue your current coverage

• Verification of Teaching Load Form - If you are working at least 40% load at SRJC, you don’t need to complete this form. You only need your other college to complete this form if you work at least 20% load, but less than a 40% load at SRJC.

** IMPORTANT: The forms on this page are all fillable and signable electronically. Once you've opened the form, please download and save the file before filling it out to access the signable electronic option.