Membership Forms

Please click below to download the forms. All benefits forms cannot be faxed or duplicated. They must be mailed or hand delivered to our office.

FORMS

Name Change Form

Change of Address form

Membership Application form

Student Verification form

Optical Enrollment Form

Dental Enrollment Form

** Please note for Dental Form only:

NEW LAW REQUIRES SOCIAL SECURITY NUMBERS FOR DEPENDENTS

The Department of health and Human Services issued a new MANDATORY Insurer Reporting Law (Section 111 of Public Law 110-173) requiring Third Party Administrators to report Social Security Numbers (SSNs) for ALL DEPENDENTS in order for Medicare to properly coordinate Medicare payments with other insurance and/ Workers' Compensation benefits.

The Washington Teachers Union will be subject to fines for failure to provide SSNs to the Centers of Medicare and Medicare Services (CMS) - more importantly YOU will not have coverage or be loaded in to the eligibility system for 2009 - 2010 if you do not provider the SSN of your dependents.

Eligibility can be reinstated once your Dependent SSNs are provided to us.

Tuition Reimbursement Form

WTU Action Team Form

WTU Nominating Petition