PDF
…AN FSA, MAKE SURE YOUR EMAIL IS LISTED ON THE 1ST PAGE!
SIGNATURE REQUIRED - Participant Authorization
By submitting this completed election form, I certify the information is accurate, understand the election is binding and cannot be changed during the
plan year, except for a qualified status change. By completing, signing and submitting this form, I…
https://www.wichita.edu/services/humanresources/Organizational_Development/New_Employee_Resources/NEO_Online/ICAA/ICAA_Enrollment_Form-Rem.pdf