ARTRS - Membership Data Form

Arkansas Teacher Retirement System
ARTRS - Membership Data Form
Original Document

You are encouraged to review the original document prior to completing this form. Your answers will be embedded on the PDF form and submitted to the proper department.
Member's Social Security Number
Name (Last, First, Middle)
Address
City
State
ZIP
County of Residence
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Mobile Phone
Email
example@example.com
Employer
Employer Code
Employer Type

SchoolCollege/State Agency
Should be Empty:

Original Document