USE THIS FORM IF YOU ARE TRYING TO - NDPERS Preview on Page 1

USE THIS FORM IF YOU ARE TRYING TO - NDPERS 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out Part A, which includes your personal information. Enter your name, NDPERS Member ID, last four digits of your Social Security Number, and date of birth.
  3. Next, provide details about the adult dependent and grandchild. Fill in the names and dates of birth for both the adult dependent (parent of the grandchild) and the grandchild.
  4. Move to Part B for member verification. Check all applicable criteria that confirm your grandchild's eligibility for coverage under the plan.
  5. If applicable, enter the name and address of the college or school where your adult dependent is a full-time student.
  6. Finally, review all entered information for accuracy. Sign and date the form to certify that all information is true and correct before submitting it along with any required documentation.

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Related links

Employee Self-Service | University of North Dakota

Log into Employee Self-Service (HRMS) to view your paycheck and W-2 form. can go online to NDPERS Self-Service. Call 701.777.2222 and press #0 for assistance

Learn more
USE THIS FORM IF YOU ARE TRYING TO

Jan 1, 2025 If You Are Trying To: Use This Form. Enrollment Waivers. Enroll an eligible new permanent employee in the. Defined Contribution Plan 2025.Read more

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