Employment change can be confusing.  JA Counter's Transition Counts team is on standby to educate individuals during times of transition!  Please fill in the information below and our Transition experts will proactively provide contact information and Transition Counts assistance to the individual identified.  

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* 1. Name of Organization

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* 2. Name of Employee:

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* 3. Date of Transition

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* 4. Employee's Street Address

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* 5. Employee's City, State, Zip

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* 6. Employee's Phone Number

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* 7. Plan Participation:

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* 8. Other Comments:

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