Reason for the Withdrawal: Verification for the reason chosen needs to be faxed to "Distribution Request" at 513.357.3199. Failure to provide verification can delay the processing of your request.

Age 59½: I have attained age 59½.

Severance of Employment:

I separated from service on (MM/DD/YYYY)

Disability

Transfer/Rollover Distribution:

I elect to move funds to another approved product provider within the Plan. (choose one):
Transfer to another 403(b) plan
Rollover to a non-403(b) plan


Information on Transfer/Rollover:

I verify that the product provider designated below is a proper recipient for my transfer/rollover.

Name of Product Provider

Upon submission, Great American Plan Administrators will verify that this product provider is approved by the school district for the purpose of receiving transfers, currently has an Information Sharing Agreement in place, and , if no Information Sharing Agreement exists, is willing to enter into an Information Sharing Agreement with the school district.

Please allow up to five days for compliance verification. A representative of Great American Plan Administrators will be in contact with you regarding the status of the request.

Resulting from one of the following:
Pay college tuition that is due in the next 12 months for you or a dependent
Make a down payment on your primary residence
Pay medical expenses for you or a dependent
Prevent foreclosure or eviction from your home