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BERKELEY UNIFIED SCHOOL DISTRICT ANCILLARY ENROLLMENT/CHANGE FORM (INCLUDES FSA ELECTIONS) Enrollment: Termination: Change:q New Enrollment q All Plans q Add Dependent loss of Other CoverageEFFECTIVE
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Any individual who wishes to enroll in ancillary programs or courses in 2019 needs to complete the ancillary-enrollment-form-2019. This form is required to provide necessary information for the enrollment process and to evaluate the eligibility of the applicant for the desired program or course.
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Ancillary-enrollment-form is a form used to enroll in additional services or benefits that are related to a primary enrollment.
Individuals who wish to enroll in additional services or benefits related to their primary enrollment are required to file ancillary-enrollment-form.
To fill out ancillary-enrollment-form, you need to provide personal information, select the additional services or benefits you wish to enroll in, and sign the form.
The purpose of ancillary-enrollment-form is to collect information from individuals who want to enroll in additional services or benefits related to their primary enrollment.
Information such as personal details, preferred additional services or benefits, and signature must be reported on ancillary-enrollment-form.
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