Forms

Trust Fund Forms

These printable forms are in PDF (Portable Document Format). To read and print these forms, you need free Adobe Acrobat Reader which is probably already installed in your system. If you do need to install it, click here.

COBRA Election Form

The COBRA Election Form is used when you or a family member has lost coverage due to a qualifying event.

Retiree Data Form

The Retiree Data Form must be completed by all employees who apply and qualify for retiree coverage.

Participant Data Form (English)

The Participant Data Form must be completed by all new employees. Eligibility and claims cannot be processed on you or your family members until this form is completed and on file in the Fund Office.

Participant Data Form (Spanish)

Same as above, but in Spanish.

SWA Medical Form

The SWA Medical Form is only for those members and their families who are covered under the Medical Reimbursement Plan (Indemnity Plan).

SWA Student Status Form

The SWA Student Status Form is to be used for dependent children age 19 through 25 who are attending a college or university.

Tier Participant Data Form (English)

The Tier Participant Data Form is only for employees covered under a plan that allows them the option of electing Single, Two-Party or Family coverage. Please verify that you have tier plan benefits before completing this form.

Tier Participant Data Form (Spanish)

Same as above, but in Spanish.