NET-2 (5/12) NY STRS NEW YORK STATE TEACHERS’ RETIREMENT SYSTEM 10 Corporate Woods Drive, Albany, NY 12211-2395 APPLICATION FOR MEMBERSHIP Please Provide All Requested Information PART 1 — TO BE COMPLETED BY APPLICANT Phone Number ( ) – Date of Birth // Month Day Year Gender Male Female Marital Status (optional) Married Single Former Name Last Name PART 2 — TO BE COMPLETED BY EMPLOYER (Refer to Section 1 of the NYSTRS Employer Manual at www.nystrs.org) –– Social Security Number Street Address Street ...
Allowed
Adobe Portable Document Format (.pdf) - application/pdf
EduTech School Districts 
