Spring ISD Benefits Exit Survey

* red star indicates - required.
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Choose Campus or Department (required)
  Check box if this is a new address.
If this is a new address, make sure to also go to the Staff Intranet and Update Contact Information (under Human Resources).
All questions below are required.
Please check all Saving Plans that you have:
If you have a 403b, 457 Plan, 529 Plan or Roth 403b,
please select a date to stop the deductions.
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Did you have Dental Insurance?
Did you have Vision Insurance?
Did you use SISD Houston Chronicle program?
If you are retiring or resigning at the end of the school year,
when would you like to terminate your insurance benefits?
(medical, dental, vision)
If not, please go to the next question.
Loan Balance
Loan Balance

COBRA information for medical insurance will be mailed from Health Care Service Corporation.
COBRA information for dental and vision insurance will be mailed from Ceridian.

TRS... For information concerning TRS funds, go to www.trs.state.tx.us or call 1-800-223-8778
For withdrawal or rollover, download the TRS-6 form and mail it directly to TRS.

I approve all information given in this exit form.