San Luis Obispo County Employees’ Association
Survivor’s Endowment Grant Program
Enrollment and Recipient Designation Form
As a benefit of Association membership, every SLOCEA member in good standing may enroll in the
Association’s Survivor’s Endowment Grant Program. The program currently pays a $3,000 cash grant,
upon the death of the member, to the member’s designated recipient (“Grant Designee”). Although this
is not an insurance program, the “Grant Designee” is similar to a beneficiary for a life insurance policy.
Enrollment in the Survivor’s Endowment Grant Program is cost free to SLOCEA members. To enroll,
please complete and return this form to the Association office via any of the following methods:
• Submit digitally via DocHub
• Mail to San Luis Obispo 93401
• Email to [email protected]
IMPORTANT:
This section MUST be completed and returned
To enroll in the Association’s Survivor’s Endowment Grant Program, this form must be completed by
the member and returned to the Association. Please fill in all the information requested and sign the
form as indicated below.
Member’s Name:
Member’s SS#
Member’s Address:
Member’s Phone #:
Member’s City / Zip:
Member’s Date of Birth:
Member’s Personal Email:
Grant Designee (designated to receive payment in the event of the member’s death):
Relationship to Member:
Grant Designee Phone:
Grant Designee Email Address:
Member’s Signature
Date of Signature
Note: The San Luis Obispo County Employees’ Association’s Survivor’s Endowment Grant Program is not an insurance program. This program is self-funded by the Association and
is intended as a benefit of Association membership. The Survivor’s Endowment Grant Program was adopted by the Association Board of Directors and is administered through the
Association’s Member Benefit Committee. The Association Board of Directors retains the right to amend, modify, abolish, or replace the Survivor’s Endowment Grant Program at any time
and without prior notice. For more information, please contact SLOCEA Staff at (805) 543-2021.