Removal from Ranked Pool of Eligibles Form Disclaimer: By submiting this form you agree to be removed from the Ranked Pool of Eligibles. Applicants who are removed from the Ranked Pool of Eligibles must re-apply during Open Enrollment. Removal from Ranked Pool of Eligibles Name Last Name Enter the last 4 digits of your Social Security Number By checking this box you agree that the information you have enter is correct and you wish to be removed from the Ranked Pool of Eligibles By checking this box you agree that the information you have enter is correct and you wish to be removed from the Ranked Pool of Eligibles I Agree 13 + 13 = Submit
