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Insurance Enrollment & Change Forms

2022 Guides and Links: 

Benefit Information

Employee Quick Contact Guide

AWC 2022 Benefit Webinar - (Password: Dupont2022!)

HRA-VEBA 2022 Informational Video

Department of Retirement Systems -DRS (on-demand videos)


Medical Forms:

  • AFLAC Enrollment Form
  • AWC Change of Address Form
  • AWC Enrollment Form
  • AWC Life Insurance and Beneficiary Change Form
  • Health Benefit Summary 2022: DEA Employees
  • Health Benefit Summary 2022: EXEMPT Employees
  • Health Benefit Summary 2022: FIRE Employees
  • Health Benefit Summary 2022: POLICE Employees
  • HSA Direct Deposit
  • Waiver of Insurance

Misc. Forms: 

  • W-4

Retirement Forms:

  • Decision Point 457(b) Enrollment Form
  • Decision Point 457(b) Elective Deferral Change Form
  • Decision Point 457(b) Investment Option Performance
  • Decision Point 457(b) Services & FAQ's
  • DRS Name/Address Change Form
  • DRS DCP Beneficiary Change Form
  • DRS DCP Enrollment Guide
  • DRS DCP Quick Enrollment Form
  • DRS PERS Plan Choice Booklet
  • DRS LEOFF Enrollment Form 2022
  • Mission Square (formerly ICMA) - 457 Enrollment Form
  • Mission Square (formerly ICMA) - Contribution Change Form
  • Mission Square (formerly ICMA) - Name Change Form
  • Mission Square (formerly ICMA) - 457 Plan Brochure
  • Mission Square (formerly ICMA) - Meet your Rep
  • Mission Square (formerly ICMA) - Retirement Planning 







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City of DuPont

  1. 1700 Civic Drive
    DuPont, WA 98327

    Phone: 253-964-8121

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