Medium

Forms Policy

  1. Digital signatures are not accepted by NDPERS.
  2. Completed forms must be submitted to NDPERS by fax, by mail, or as a scanned PDF.
  3. NDPERS does not accept picture files such as .jpeg, .jpg, .tif, or .png.

Select a form to download:

Enrollment or Cancellation of Coverage

Continuation of Group Insurance Coverage - COBRA
Dakota Plan (Non-Medicare) Enrollment
Dakota Retiree Plan (Medicare) Enrollment
Disenrollment 

    Dependent Disability

    Access to Communications - Protected Health Information

    Other general forms