Dental and Vision Enrollment Form Instructions

  1. Complete the applicable fields on the next page.
    • Provide your personal details (name, address, date of birth). If you are enrolling a spouse/domestic partner and/or other eligible dependent(s), provide their personal details as well.
  2. Click the Populate Form button at the bottom of the next page.
    • This will generate the Dental Enrollment Form (STD. 692) or the Vision Enrollment Form (STD. 700) with the information you provided.
    • Print or save your autogenerated form to a secure local drive. Do not save your form to a public computer.
  3. Form Submission: Consult with your departmental personnel office on acceptable form submission methods. If your departmental personnel office allows electronic submission (via secure email) with a digital signature, proceed with the Electronic Option steps. Follow either the Electronic Option or the Hard Copy Option steps below to complete and submit the remaining sections of the form.
    • Electronic Signature Option (preferred option):
      • Save your autogenerated form to a secure local drive. Do not save your form to a public computer.
      • Open your saved form, complete the required Social Security Number (SSN) field(s), review the form, add your digital signature with date, and save your completed form.
      • Email the completed form securely to your departmental personnel office.
      • Delete your form from your local drive and your sent outbox to minimize the risk of personal information exposure in case of a security breach.
    • Hard Copy / Wet Signature Option:
      • Print the generated form in a secure location.
      • Using an ink pen, complete the SSN field(s), review your information, then sign and date the form.
      • Submit the form as directed by your departmental personnel office.

Reminder: Generating your form through this website does not submit the form to your departmental personnel office.


Note: The next page is intentionally designed not to request and capture SSNs. The populated form also prevents you from saving it with SSNs to safeguard the privacy of all employees and their dependents. For more information about privacy safeguards please review our Privacy Policy page.