Trooper Plan A: Forms
The West Virginia State Police Death, Disability and Retirement Fund (Plan A) Forms
- Application for Scholarship
- Authorization to Release Information
- Benefit Estimate Request
- Combined Medical Power of Attorney and Living Will (print on legal size paper)
- Confidential Records Order
- Disability Recertification Policy
- 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)
- Online Self-Service Get Started Guide
- Qualified Domestic Relations Order (QDRO)
- Retired Public Safety Officer Authorization for Insurance Premium Deduction (PSOA-2025)
- Retired Public Safety Officer Insurance Carrier (ICA)
- State of West Virginia Statutory Form Power of Attorney