PEERS Home


PEERS Forms

These forms are stored in PDF format. If you have the free Adobe Acrobat Reader software you can fill the forms out and print them, you cannot save them to another location. Please note that you must click the "clear" button in order to delete the information you entered into this form.

Click the Acrobat Reader icon to download this free program.
Please retain a copy of all completed forms for your records.

General Forms
Adobe Acrobat Address Change Form
Adobe Acrobat Name Change Form
If your name has changed due to a marriage or a divorce, you may also need to fill out and submit a new Nomination of Beneficiary form. Click the link below to access that form.
Adobe Acrobat Nomination of Beneficiary*
Protecting Those You Care About Brochure

 

 *This Nomination of Beneficiary form should only be completed by an individual who is currently employed in a PEERS-covered district or by an individual who has an active membership with PEERS but is not currently working in a PEERS-covered district. If neither category applies, call our office at (800) 392-6848.
   
Purchasing Service Forms
If you are filling out a purchase application and plan to pay with money that is rolled over from a qualified account, please print and complete the Rollover/Transfer Certification form below.
Adobe Acrobat Reinstatement Application
Adobe Acrobat PEERS Purchase of PSRS Credit
Adobe Acrobat Supplemental Credit Purchase Application
Adobe Acrobat Social Security Purchase Application
Adobe Acrobat Public School Purchase Application
Adobe Acrobat Private School Purchase Application
Adobe Acrobat Maternity Leave Purchase Application
Adobe Acrobat Military Purchase Application
Adobe Acrobat Vo-Tech Purchase Application
Adobe Acrobat Not-for-Profit Purchase Application
   
Rollover Form/Instruction Sheet
Adobe Acrobat Rollover/Transfer Certification for Pre-Tax Funds (For the Purchase or Reinstatement of Service Credit)
Adobe Acrobat Rollover/Transfer for Pre-Tax Funds Instruction Sheet
 
   
Getting Ready to Retire Forms
Adobe Acrobat Tax Withholding Authorization
Adobe Acrobat Direct Deposit Authorization Form for Electronic Funds Transfer of Monthly Benefit Payments (EFT)
Acrobat - PDF file Service Retirement Application
Please print and complete the Tax Withholding Authorization (above) and the Direct Deposit Authorization Form (above) with this application.

-If you plan to elect PLSO at retirement, you must file a PLSO Distribution Form with this application.
-If you plan to elect the Accelerated Payment Plan (APP), please contact our office for the appropriate retirement application. Do not use this form.
Acrobat - PDF file PLSO Distribution Form
Complete this form only if you are filing for service retirement and selecting a PLSO plan.
Acrobat - PDF file

Disability Retirement Application
Please print and complete the Tax Withholding Authorization (above) and the Direct Deposit Authorization Form (above) with this application.
   

Please call our office at (800) 392-6848 to request the following forms:
  Application for Withdrawal
  Application to Purchase USERRA
  Application to Purchase Reciprocity
  Application to Purchase Part-Time Certificated Service
  Application to Purchase Non-Federal Public Employment
 
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