Enroll

Use the form below to enroll in the Texas State Optical Vision Plan.

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TSO Office*

First Name*

Last Name*

Street Address*

City*

State*

Zip Code*

Cell Phone*

Email Address*

Date of Birth*

Family Members*

How many family members are residing at the same residence? You can include up to 5.

Family Member 1

First Name

Last Name

Cell Phone

Email Address

Date of Birth

Relationship to the Primary member

Family Member 2

First Name

Last Name

Cell Phone

Email Address

Date of Birth

Relationship to the Primary member

Family Member 3

First Name

Last Name

Cell Phone

Email Address

Date of Birth

Relationship to the Primary member

Family Member 4

First Name

Last Name

Cell Phone

Email Address

Date of Birth

Relationship to the Primary member

Family Member 5

First Name

Last Name

Cell Phone

Email Address

Date of Birth

Relationship to the Primary member

Enroll

Family Member 1

Family Member 2

Family Member 3

Family Member 4

Family Member 5

Application Review