Enrollment in the Peralta Colleges Benefits Plan is mandatory for employees (and their eligible dependents) who wish to participate in the welfare benefits program. Please fill out the form provided and return it to the benefits department for processing.  Please retain a copy of the enrollment form for your reference. This will serve as verification of enrollment while you wait for your identification cards from the applicable carriers.

If you would like to opt out of the Medical and Dental Insurance plans and recieve cash lieu of enrollment, please download, fill out, and return the Cash in Lieu Form provided below.