SERS Membership Record Form

School Employees Retirement System of Ohio Membership Form

Please download the form using the button below, then fill in the electronic form below.

Download SERS Form
Name(Required)
Permanent Mailing Address(Required)
Gender(Required)
Date of Birth(Required)
Marital Status(Required)
Family Data
Spouse
First
Middle
Last
Maiden
Date of Birth
 
Child(ren)
First
Middle
Last
Maiden
Date of Birth
 
Father
First
Middle
Last
Maiden
Date of Birth
 
Mother
First
Middle
Last
Maiden
Date of Birth
 
Job Classification(Required)

Membership in Other Ohio System

For each of the following, check "yes" or "no" if you ever were a member of or received benefits from:

School Employees Retirement System of Ohio
Member
School Employees Retirement System of Ohio
Benefit
State Teachers Retirement System of Ohio
Member
State Teachers Retirement System of Ohio
Benefit
Ohio Public Employees Retirement System
Member
Ohio Public Employees Retirement System
Benefit
Ohio Police & Fire Pension Fund
Member
Ohio Police & Fire Pension Fund
Benefit
Ohio State Highway Patrol Retirement System
Member
Ohio State Highway Patrol Retirement System
Benefit
Cincinnati Municipal Retirement System
Member
Cincinnati Municipal Retirement System
Benefit
I hereby certify the information given here to be true to the best of my knowledge.
Back to Additional Paperwork Page