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 Joinder Agreement
• LSS Special Needs Pooled Trust Master Trust Agreement

North Dakota

• LSS Self-Settled (Special Needs) Pooled Trust Joinder Agreement
• Self-Settled Pooled Trust Grantor's Wishes for the Use of Funds
• IRS W9 Form
• LSS Self-Settled (Special Needs) Pooled Trust Master Trust Agreement