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USE THIS FORM ONLY FOR THE KAISER HSA PLAN California Region Kaiser Permanent Group Enrollment Form PLEASE INITIAL Please print or type in black ink only. Make a copy for your records.TO BE COMPLETED
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Form Acalanes Center is for reporting financial information related to tuition and fees paid for educational purposes.
Parents or guardians who have paid tuition and fees for educational purposes on behalf of a student are required to file Form Acalanes Center.
Form Acalanes Center can be filled out by providing information regarding the student, the educational institution, and the amount of tuition and fees paid.
The purpose of Form Acalanes Center is to report financial information related to educational expenses for tax purposes.
Information such as the student's name, the educational institution's name, and the total amount of tuition and fees paid must be reported on Form Acalanes Center.
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