Benefits Resources & Forms
Benefits forms require Adobe Acrobat Reader to view and print. You may download this free software by clicking on the following link: Get Adobe Acrobat!
Enrollment
Benefits Enrollment Form (pdf; requires legal size paper to print)
HIRD (Health Insurance Responsibility Disclosure Form) - Benefits Eligible (pdf)
Reimbursement
Blue Cross Fitness Reimbursement Form (pdf)
Blue Cross Weight Loss Reimbursement Form (pdf)
EBPA Reimbursement Accounts Claim Form (pdf)
EBPA Reimbursement Accounts Direct Deposit Form (pdf)
Leaves of Absence
Application for Leave of Absence (pdf)
NU-UNUM Claim for Income Protection (pdf)
Life Insurance
Evidence of Insurability Form/UNUM (pdf)
Retirement
Fidelity Investments Account Application (pdf)
Fidelity Investments Beneficiary Form (pdf)
Fidelity Investments Fund Options (pdf)
Fidelity Investments Transfer/Rollover Form (pdf)
Retirement: Basic and Disability Waiver Form (pdf)
Retirement Plan Salary Reduction Agreement (pdf)
TIAA-CREF Basic Account Application (pdf)
TIAA-CREF Supplemental Account Application (pdf)
TIAA-CREF Beneficiary Form (pdf)
TIAA-CREF Fund Options (pdf)
TIAA-CREF Transfer/Rollover Form (pdf)
Tuition
Tuition-Dependent Certification Form (word)
Tuition Deposit Form (pdf)
Tuition-Graduate Job Related Designation Form (pdf)
Tuition Waiver Form (pdf)
Other
Long-Term Disability Waiver (pdf)
Pre-Tax Transit Pass Order Form (pdf)
Same-Sex Spousal Equivalency Certification Form (pdf)
Summary Annual Report (pdf)
Summary Plan Document (pdf)