Forms below are interactive -- you may type information directly onto the form. Once completed, print out the form, sign form (if applicable), and return it to LACERS via mail, fax, or in person:
202 W. First Street, Suite 500
Los Angeles, CA 90012-4401
* For dependents between the age of 19 and 25, completing the Student Verification portion of the enrollment form is the first step. Members still must submit additional documents - Proof from school and for Kaiser members the Kaiser Student Certification form.