Benefit Fund Forms

The most commonly used Benefit Fund forms are listed below. If you have questions about how to complete or submit them, you may contact our Benefit Fund administrator Mary Kaffaga in any of the following ways:

• by email — mary@fascc.org
• by phone — 631-451-4323
• in person — Southampton 224D, Ammerman Campus

Dental Claim Form 

Hearing Aid Benefit Form

Dependent Child Care Benefit

Prescription Claim Form

Student Verification Form