All Enrollment Benefit Forms will need to be submitted using AdobeSign.

Health & Dental Enrollment 

• Benefits Worksheet New Hire/ACA
• Benefits Worksheet (Family Status Change)

Vision Plan Premier Enrollment

• 2026 VSP Premier Enrollment Form Last Names A - L
• 2026 VSP Premier Enrollment Form Last Names M - Z
• Vision Reimbursement Form (Out-of-network)
• Vision VDT Claim Form

Other Resources

• Affidavit of Marriage/Domestic Partnership
• Affidavit of Parent-Child Relationship (HBD-40)
• Domestic Partnership Certification
• Domestic Partnership Taxable Income for Benefits
• Process to Continue Benefits for Disabled Dependent beyond Age 26
• Collection of Dependent Social Secuirty Numbers
• HIPAA Authorization to Use and/or Disclose Personal Health Plan Information
• Medical Non-Participating Tax Advantage Premium Plan (TAPP) form

 

• 2026 HCRA and DCRA Enrollment/Change Form - Last Names A - L
• 2026 HCRA and DCRA Enrollment/Change Form - Last Names M - Z
• ASIFlex Quick Guide
• 2026 HCRA Brochure
• 2026 DCRA Brochure

• Catastrophic Leave Donation Program (CLDP) Donation Form
• Request for Participation Form - Please contact the Leave Coordinator, Jennifer Olsen, for Participation Form
• Catastrophic Leave Donation Program Summary

Fee Waiver Application: 

• Fee Waiver applications are available through Optimize. Please click here for the link.
• Career Development Plan (CDP) Form last name A-L
• Career Development Plan (CDP) Form last name M-Z
• Admission Data Form

If you need more information on medical and non-medical leaves of absence, or need to start the process, complete the Leave Inquiry form or contact the Leaves Coordinator.

Jennifer Olsen
Confidential Leaves and Accommodations Coordinator
jennolsen@csufresno.edu
559.278.5345

Pre-Tax Parking Deduction Plan Cancellation Form