TR-0266 (Rev. 5/19)
RDA-413
Notice of Election
to Participate in the
ORP or the TCRS
Tennessee Consolidated Retirement System
502 Deaderick Street
Nashville, Tennessee 37243-0201
1-800-770-8277 http://tcrs.tn.gov
This election is made with the understanding that you must participate in either the Optional Retirement Program
(ORP) or the Tennessee Consolidated Retirement System (TCRS) under the following conditions:
(1) You cannot participate in both plans at the same time;
(2) With limited exceptions, the election to participate in the ORP is generally irrevocable as long as you work
for a state-supported institution of higher education in an ORP-eligible position; and
(3) Under current law, a member of TCRS who is eligible to participate in the ORP may elect to transfer
prospective membership to the ORP upon complying with specified filing requirements. Employee
contributions may be transferred, but employer funds will not be transferred.
Please select one of the following:
I hereby elect to participate in the Optional Retirement Program and, thereby, waive my right to participate
in the Tennessee Consolidated Retirement System.
I hereby elect to participate in the Tennessee Consolidated Retirement System and, thereby, waive my
right, at this time, to participate in the Optional Retirement Program.
SECTION 1. APPLICANT INFORMATION
Member ID Last 4 SSN XXX-XX- Date of Birth
Full Name Gender
Male Female
Mailing Address
City State Zip Code
Email Phone Number
Employer Department Code
Title of Position
Date of Employment Date of First ORP Contribution
Have you ever been a member of the Tennessee Consolidated Retirement System?
Yes No
If yes, give the name of the Department in which you were employed
Have you ever made contributions to the ORP through a school located in Tennessee?
Yes No
If yes, give the name of the school or institution
I have read the foregoing instrument and have elected to join either the ORP or the TCRS and execute a waiver
of all prospective benefi ts in the plan for which I have elected not to join.
Applicant’s Signature Date
