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Membership Forms

  • Beneficiary Designation: Use this Beneficiary Designation form to tell ERSRI who you would like to name as your primary and contingent beneficiaries.
  • TIAA-CREF Beneficiary Designation:  If you worked after June 30, 2012 within ERSRI, please remember to update your beneficiaries with TIAA-CREF as well.  To be redirected to TIAA-CREF's website and change your beneficiary online click www.tiaa-cref.org/beneficiaries  OR to print and mail the form, click www.tiaa-cref.org/beneficiary.  This form must be sent directly to the TIAA-CREF address located on the form.
  • AETNA Life Insurance Beneficiary Designation:  Use this AETNA Life Insurance Beneficiary Designation form if you would like to name a new beneficiary on your AETNA policy.  This form must be sent directly to the AETNA address located on the form.
  • Agreement of Trustee/Custodian: Use this Agreement of Trustee/Custodian form if you have left your job and would like to roll your contributions into another qualified retirement plan.
  • Affidavit of Domestic Partnership: Use this Affidavit of Domestic Partnership form to tell ERSRI about your Domestic Partnership or the termination of a Domestic Partnership.
  • Salary Verification for Service Credit: Use this Salary Verification for Service Credit form to help ERSRI determine your service credits based on salary.
  • Day Count Verification: Use this Day Count Verification form if you are a teacher who needs ERSRI to determine your service credits based on the number of days you have worked.
  • Application for Termination Packet: Use this Application for Termination Packet if you are a member of ERSRI/MERS and are requesting a refund of contributions.
  • Employer Certification Termination: Use this Employer_Certification_Termination_form upon termination of employee.