Employee Benefits Enrollment Form

Use this form to enroll in UK health benefits, including our health, dental, and vision plans for the plan year that runs July 1, 2016, through June 30, 2017.

PLEASE NOTE: You must download the form and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.

Return form to (email address): 
Benefits Office, 112 Scovell Hall
Revision date: 
Return form to (address):