Benefits Forms

• 2008 Benefits Election Form (PDF) 
• Waiver form (PDF)
• Qualifying Event (PDF)
• Student Dependent form (PDF)
• HIPAA form (PDF)
• BCBS Claim Form (PDF)

Medical information

• 2008 Benefits Election Form (PDF) 
• Waiver form (PDF)
• Qualifying Event (PDF)
• Student Dependent form (PDF)
• HIPAA form (PDF)
• Delta Claim Form (PDF)

Dental information

• Request for Change (PDF)
• Evidence of Insurability (PDF)
• Beneficiary Form (PDF)
• Voluntary Life and AD&D Enrollment form (PDF)
• Voluntary Life Waiver Form (PDF)

Life Insurance/AD&D Information

• Certification of Health Care Provider - Family (PDF)
• Definition of Serious Health Condition (PDF)
• Certification of Health Care Provider - Employee (PDF)
• Fitness for Duty Certification (PDF)
• LTD Tax Election Form (PDF)

Disability Information

• Accident/Incident Form (PDF)
• Physician's Report/Work Status (PDF)

Worker's Comp Information

• 2008 Salary Reduction Agreement Voluntary 403(b) Form (PDF)
• Fidelity Change of Beneficiary (PDF)
• TIAA-CREF Change of Beneficiary (PDF)
• Carrier Change Form -  MS Word or PDF

Faculty Voluntary Retirement Incentive Program

• Monetary Incentive Option Application Form - MS Word or PDF
• Phased Retirement Option Application Form - MS Word or PDF
• Voluntary Resignation Form - MS Word or PDF
• Claim Release - Faculty - MS Word or PDF
• Retirement Arrangements for Tenured Faculty SPD - PDF

Retirement Information

• Undergraduate Application
• Graduate Application
• ACTC Application (PDF)

Tuition Remission Information

• Medical and Daycare Expense Claim Form (PDF)
• HIPAA (PDF)
• Direct Deposit Authorization (PDF)
• 2008 Benefits Election Form (PDF)

Health Care & Dependent Care Spending Information

• Certification of Health Care Provider - Family (PDF)
• Certification of Health Care Provider - Employee (PDF)

Family Medical Leave Act Information