403(b) Automatic Enrollment Opt-Out Form

Submit this form within 30 days of initial notification of auto enrollment. If you have had deductions taken for auto enrollment, you can not use this form to opt out. Please contact a benefits team member at x2834 or x2547 regarding available options.

By submitting this Automatic Enrollment Opt-Out Form, I elect not to enroll under the auto enroll provision of the University of San Francisco's 403(b) Plan. I understand that no salary deferral contribution will be made unless and until I sign a Salary Reduction Agreement.

NOTE: INTERNET EXPLORER DOES NOT SUPPORT THIS FORM SUBMISSION. PLEASE COMPLETE THIS FORM IN A FIREFOX, SAFARI OR CHROME WEB BROWSER.

Employee First Name:  

Employee Last Name:  

USF ID Number*:          

USF Email Address:     

Form is not complete until you have clicked "Submit Form" and received the confirmation message.

*If you don’t know your USF ID number, please follow these steps:

1.      Go to site http://connect.usfca.edu

2.      At the bottom of the green box on the top left, click on "Don't know your USF ID?".

3.      Look to the bottom of the text and click on "USF ID Number Lookup".

4.      Input USF username and password to have your ID listed.

If you require assistance with this form, please contact Benefits at benefits@usfca.edu.

Thank you.