Change of Status Forms

Are there changes in your employee status, or a change in your dependents status?  Please print and complete required form found on the link below and email it to

Recently married, divorced, new baby, change of name, address, remove a dependent who is no longer a full-time student? Please complete the required form found on the link below and email it to

  karen.weise@pvtrustfund.org


Change of Status Form