Health Forms

• Health Election Form for Active Employees
• Health Care Enrollment Form for Extended Coverage (PDF)
• Rates for Extended Coverage
• Spring 2012 Spotlight

Pretax Forms  

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

Leave Forms  

• FMLA Request Forms
  • Employee FMLA Request Form (PDF)
  • Family Member FMLA Request Form (PDF)
• Medical Certification Forms 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

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)

Miscellaneous

• Credit Union Application
• Savings Bonds