Health Forms

• Health Election Form for Active Employees
• Health Care Enrollment Form for Extended Coverage (.pdf)
• Rates for Extended Coverage
• Spring 2008 Spotlight

Pretax Forms  

• EZ Reimburse Guidelines
• Flexible Benefits EZ Mastercard Enrollment Form
• Flexible Reimbursement Account Election Form (.pdf)

Leave Forms  

• FMLA Request Forms (.pdf)
• Medical Certification Form from Department of Labor
• Donor Leave Sharing Forms (giving/receiving) (.pdf)
• Community Service/School Participation Form (.pdf)

Voluntary Savings 403(b) Forms

• Salary Reduction Agreement 2008

Enrollment

• TIAA-CREF - Contact HR
• AIG
• METLIFE

Deferred Compensation Forms

• 457 Enrollment Application
• 457 Beneficiary Form

Pension Forms (Faculty Only)

• ORP Election Form (.pdf)
• Termination Certificate Form (.pdf)
• ORP Health Credit Form (.pdf)

Virginia Retirement Forms

• VRS/VSDP Form (.pdf)

VRS-Purchase Prior Years of Service

• Purchase Prior Years of Service (.pdf)
• Purchase Service Credit-Post-Tax (.pdf)
• Purchase Service Credit-Pre-Tax (.pdf)

Life Insurance Forms

• Beneficiary Form (.pdf)
• Optional Group Life Enrollment Form (.pdf)
• Group Life Insurance Evidence of Insurability Form (.pdf)

Termination of Employment (Due to Retirement)

• Letter of Resignation Form
• Disability Credit Form (.pdf)
• Health Insurance Credit Form (.pdf)
• Health Benefits (Retirement/VSDP/LTD) (.pdf)
• VRS Request for Refund (.pdf)
• Name and Address Declaration for Deferred Members (.pdf)

Miscelaneous

• Credit Union Application
• Savings Bonds