Vision Application Instuctions

If you are enrolling for the first time only fill out the top half of the application (section 1). The fields highlighted in dark blue must be filled in.

If you are including spouse or dependents an SSN will be required for those family members.

Sign & date where indicated then be certain to  click
DONE when finished

OR click below for a printable application.
When filled out please give it to Jenna Juersivich
Best, easiest way to fill out application.
QR Code to fill out on your phone!.