Forms

Benefit Forms

• • Medical Enrollment Form
  • Dental Enrollment Form
  • Vision Enrollment Form
  • Flexible Spending Account Enrollment Form
  • Flexible Spending Reimbursement Form
  • Group Benefits Enrollment Form
  • Group Benefits Change Form
  • Health Saving Plan Enrollment Form
  • Life Evidence of Insurability Form
  • Salary Deferral Agreement-UA
  • Retirement TIAA-CREF Beneficiary Change Form
  • Retirement Fidelity Investments Beneficiary Change Form
  • Pharmacy Appeal Form
  • Medical Appeal Form
  • Family Medical Leave Request Form
  • Parental Leave and  FML Certification Form

New Employee

• W-9
• J-1 Visa for Visiting Scholars
  

Payroll Forms

• Direct Deposit Authorization Form
• Direct Deposit (Secondary) Form
• Payroll Deduction Authorization
• Freeze/Advertise
• Manual Check Form
• Faculty/Staff Meal Pricing

General Forms

• Accommodations Process for Faculty and Staff with Disabilities
• Concurrent Employment Form (Internal)
• Employee Accommodation Request Form
• Grievance Form
• Tuition Waiver Form – Spouse-Dependent

Physician Certification Forms

• WH-380-Employee Physician Certification Form FMLA
• WH-380-Family Member Physician Certification Form