Retirement Election Form

Retirement Election Form
Biographical Information
Name*
First NameLast Name
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date of Birth*
MonthDayYear
Date
Gender*
FemaleMaleOther
Employee identification number*
Hire Date*
MonthDayYear
Date
Election
Choose only one.
I choose to join the state retirement system, which I am eligible for.(STRS Ohio, OPERS, SERS)I choose to take part in an ARP: (Select only one of the ARP carriers listed here.) To enroll, you must contact your selected carrier.)(Equitable Life Assurance Company Great American Life Insurance Company, Lincoln National Life, Nationwide Life Insurance Company, TIAA-CREF, VALIC, Voya Financial Partners, Inc)
I realize that I will not be able to change my election to participate in the state retirement system once my election period has expired, and that my election will be irrevocable while I am employed at The University of Akron in any capacity. A defined-contribution plan may be available to eligible employees. For more information about these programs and eligibility, contact your applicable retirement system.*
Clear
I realize that by deciding to join in an ARP, I am giving up my entitlement to participate in the qualifying state retirement system while employed at The University of Akron in any position. I further understand that by deciding to participate in an ARP offered by a private plan provider, I will be permanently precluded from claiming or purchasing service credit or participating in other state retirement system plans for the duration of my ARP election.*
Clear
Authorization
I thus certify the above-mentioned Section II choice. If I cease to be continuously employed or am subsequently employed full-time by another Ohio public institution of higher education in a position for which a retirement election is available, I understand that I will be able to make an election to participate in another ARPor Ohio public retirement system.
Signature*
Clear
Date*
MonthDayYear
Date
ONLY FOR THE USE OF THE OFFICE OF HUMAN RESOURCES

Only for ARP Elections*

	Amount
Contributions from employees
Contributions from employer
Contributions from employers to the ARP provider
Date of the most recent payroll report containing employee contributions to the applicable state system

Applicable state system*
STRS OhioOPERSSERS
Annual remuneration*
Date the university/college received the election form*
MonthDayYear
Date
University/College*
Employer Code
Should be Empty:

Retirement Election Form

Biographical Information

Election

Authorization

ONLY FOR THE USE OF THE OFFICE OF HUMAN RESOURCES