Acknowledgement Form MAP

The following has been received and/or reviewed during today’s orientation:
- Benefits Welcome Letter — How to Enroll
- Highlights of Your Benefit Program – UFT
- Opt Out Form
- Overview of Employee Benefits
Acknowledgement

On this date, I attended the Benefits Orientation session. The content of this Orientation is described above.
Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Session ID
Should be Empty: