View and Print Benefit Forms:

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• Medical/Dental Enrollment Form

• Memo: Adding A Spouse/Domestic Partner
• Marriage/Domestic Partner Affidavit
• Termination of Domestic Partnership

• Flexible Spending Account Enrollment Form
• Health Care Spending Claim Form
• Dependent Care Spending Claim Form

• Basic Life & ADD Enrollment Form
• Voluntary Life & ADD Enrollment Form

• Nonexempt Long Term Disability Buy-Up
• Exempt Supplemental Disability Insurance

• Retirement Contribution Form
• Sample GRA Waiver Letter

• Application for Tuition Remission
• Preliminary Application for National Tuition Exchange
• Tuition Exchange Recertification Application
• Tuition Reimbursement Form

Family/Medical Leave:

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The Family/Medical Leave policy allows qualifying employees to take up to 12 weeks of unpaid leave within a 12-month period for their own serious medical condition, to care for an immediate family member with a serious health condition, for the birth or placement of a child for foster-care or adoption, or to care for their sick child. There is a separate 12-week leave allowed for conditions related to pregnancy.

• General Information About Family/Medical Leaves
• Family/Medical Leave Request Form
• Physician Certification
• Authorization for Release of Employee's Protected Health Information
• Authorization for Release of Dependent's Protected Health Information
• Fitness for Duty Form
• Personal Health Info Relase for Claims Resolution