• Application for Refund of Accumulated Contributions
• Application for Scholarship
• Authorization to Release Information
• Change of Address
• Change of Name
• Combined Medical Power of Attorney and Living Will (print on legal size paper)
• Confidential Records Order
• Employee of the Month Nomination Form
• Less Than Honorable Service
• Living Will (print on legal size paper)
• Medical Power of Attorney (print on legal size paper)
• Qualified Domestic Relations Order (QDRO)
• Request for Disability Packet
• Request for Estimate of Retirement Benefits
• Retired Public Safety Officer Authorization for Insurance Premium Deduction (PSOA-2010)
  • PSOA Information Sheet
• Retired Public Safety Officer Insurance Carrier (ICA)

WV State Police Death, Disability and Retirement Fund (Plan A)
Forms