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Commonwealth of Pennsylvania - Public School Employees Retirement System 5 N 5th Street Harrisburg PA 17101-1905 Toll-free 1. 888. 773. 7748 www. psers. state. pa.us Fax 717. 772. 3860 PSRS-1128 11/2015 Mail Center Application to Purchase Credit for PSERS Health Insurance Program Cadet Nurse Service INSTRUCTIONS Complete this form and return it to the above address. A copy of Form 300-A indicating your admission and termination dates must be attached to this application. If you do not have...
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