2022 Family Status Change Form

Updated May 17, 2022

Updated May 17, 2022

File Description

A family status change is a qualifying life event, such as marriage, divorce, birth, adoption, death, etc.  Use this form, along with an enrollment form, to make changes to your benefits enrollment.

Use this form, along with an Enrollment Form and a SJCSD Spousal Surcharge Affidavit, when making a change to your current benefits.