Page 85 - C:\Users\jsalazar145\Documents\Flip PDF Professional\new-employees-benefits-guide-2019 030619\

Human Resources – Employee Benefits
201 W. Sheridan, Bldg. A
San Antonio, TX 78204-1429
Phone: (210) 485-0200
Fax: (210) 486-9074

ALAMO COMMUNITY COLLEGE DISTRICT (ACCD)
ELECTION TO PARTCIPATE IN OPTIONAL RETIREMENT PROGRAM (ORP)

Employee Name: _______________________________ SS No: ____________ Banner ID____________
please print legibly
Employee Address: _____________________________ City______________ State________ Zip______

I, the employee whose name and signature appear on this form, have been advised by Human
Resources (HR) that I am eligible to participate in the ORP or the Teacher Retirement System of Texas
(TRS).

I hereby elect to participate in the ORP, initially, or because I have previously participated in the ORP
during prior employment with ACCD or another Texas public institution of higher education.

I acknowledge that HR has provided me with the booklet, An Overview of TRS and ORP-For Employees
Eligible to Elect ORP, prepared by the Texas Higher Education Coordinating Staff, and that I will have
read it before making this election. I understand that participation in the ORP requires me to set up a
personal investment account(s) with a vendor-company approved by ACCD, to select my investments
from products offered by the vendor-company, and to manage my investment account(s).

I understand that my ORP account shall be funded through mandatory contributions made by me and
ACCD based on percentages of my gross salary as established by the Texas legislature. I authorize ACCD
to reduce (deduct from) my gross salary, on a tax-deferred basis each pay period, by the established
percentages for my contribution to my personal investment ORP account. I understand that ACCD will
remit my and its contributions to the vendor-company for deposit and crediting to my personal
investment account.

I have selected the following vendor-company approved by ACCD and have contacted it to set up my
personal investment account. I have also submitted, along with this form, the required paperwork as
outlined in the Notification of Employee Responsibilities Under Texas ORP document.

Vendor: _________________________________ Vendor Representative: ________________________

Employee Signature: _________________________________________ Date: ____________________

Receipt of this form, signed and completed, is acknowledged by:

HR Benefits Representative: _______________________________________ Date: _______________
please print legibly

HR Benefits Representative Signature: ____________________________________________________

Instructions: Complete/ sign this form, keep a copy, submit original along with the required paperwork to your HR Benefits Representative.

orp election form 02042014

85