Downloads: Enrollment, Disbursement and Resources

Enrollment Documents:

Please visit here for other items that must be included with enrollment.

First-Party (required)

•  First-Party Declaration of Trust: Please read before signing a First-Party Joinder Agreement.

•  First-Party Joinder Agreement: Must be signed, original, notarized.

•  Notice of Fees: Must be signed, original.

•  Beneficiary Information Form: To be submitted along with a joinder agreement or when benefits and contact information change.

Third-Party (required)

•  Third-Party Declaration of Trust: Please read before signing a Third-Party Joinder Agreement.

•  Third-Party Joinder Agreement: Must be signed, original, notarized.

•  Notice of Fees: Must be signed, original.

•  Beneficiary Information Form: To be submitted along with a joinder agreement or when benefits and contact information change.

Disbursement Documents:

•  Permissible Disbursements Examples of what the Trust can pay for based on benefits received.

•  Disbursement Request Form: Please submit this form along with corresponding receipts when requesting a disbursement.