Special Needs/Self-Funded Pooled Trust Forms

To open a Special Needs Pooled Trust, complete and sign the following forms for the individual’s state of residence:

Minnesota

LSS Special Needs Pooled Trust Master Trust Agreement — PDF

LSS Special Needs Pooled Trust Joinder Agreement — DOC

Grantor Wishes Document for Uses of Funds — DOC

IRS W9 Form — PDF

North Dakota

LSS Self-Settled (Special Needs) Pooled Trust Master Trust Agreement – PDF

LSS Self-Settled (Special Needs) Pooled  Trust Joinder Agreement– DOC

Self-Settled Pooled Trust Grantor's Wishes for the Use of Funds – DOC

IRS W9 Form – PDF