Forms

Forms for New Hires [+]

Foreign National Payment Procedures [+]

Benefits Forms and Documents [+]


  How Benefits Are Affected When Employment Terminates
  Status of Your Benefits Upon Termination - Full-time Faculty and Staff (PDF)   2013 COBRA Rates (PDF)
 
Statement of Domestic Partnership
  Statement of Domestic Partnership (PDF)    
 
Dental Care Plans (Delta Dental)
  PPO Plan Reimbursement Claim Form (PDF)
  DeltaCare (DHMO) Summary of Benefits (PDF)
  Enrollment/Change Form - Full-Time Faculty and Administrative Staff (PDF)    Dental PPO Plan Summary (PDF)
  Enrollment/Change Form - Part-Time Faculty (PDF)
   
 
Flexible Spending Accounts (EBPA)
  IRS Eligible Expenses (PDF)   Direct Deposit Form (PDF)
  Over-The-Counter Items Eligible for Reimbursement   Dependent Care Expenses Cost Estimation Worksheet (PDF)
  Dependent Care Claim Form (PDF)   Health Care Expenses Cost Estimation Worksheet (PDF)
  Health Care Claim Form (PDF)   Additional Benefits Card Request Form (PDF)
 
Health Care Plan 
  Health Care Enrollment/Change Form for Full-Time      Faculty and Administrative Staff (PDF)   Health Care Enrollment/Change Form for Part-Time Faculty (PDF)
  Summary of Benefits and Coverage (SBC)- Choice Plus 500 (PDF)   Summary of Benefits and Coverage (SBC)-Choice Plus 1000 (PDF)
  Summary of Benefits and Coverage (SBC)- Choice EPO (PDF)   Summary of Benefits and Coverage (SBC)- High Deductible Health Plan (PDF)
  UnitedHealthcare Reimbursement Claim Form (PDF)   UnitedHealthcare Reimbursement Claim Form For Mental Health Services Only  (PDF)
  UnitedHealthcare's Health Discounts Program (PDF)   The New School Health Plan Notice of Privacy Practices—Self-Funded Plans (PDF)
  UnitedHealthcare Vision Plan 
  Prescription Drug Coverage
  Health Saving Account Application (PDF) (available only if enrolled in the High Deductible Health Plan)   Health Saving Account - Employee Contribution Form (PDF) (available only if enrolled in the High Deductible Health Plan)
 
Oxford Gym Membership Reimbursement Form (PDF) (for 2012 gym visits only - must be submitted within 180 days of last gym visit)
  Oxford Reimbursement Claim Form (PDF) (for 2012 medical and vision care expenses only - must be submitted within 180 days of date of service)
 
Life Insurance Plan (The Standard Life Insurance Company of NY)
  Life Insurance Beneficiary Designation Form (PDF)   (PDF)
 
Long Term Care Information
  Long Term Planning Associates, LLC (PDF)    
 
Long-Term Disability Plan (The Standard Life Insurance Company of NY)

  Long-Term Disability Plan Certificate and Summary Plan Description (PDF)    
 
Qualified Transportation Expenses (QTE) Plan (EBPA)
  Enrollment/Change Form (PDF)   Direct Deposit Form (PDF)
  Reimbursement Claim Form (PDF)   Plan Summary (PDF)
 
Retirement - Tax-Deferred Annuity (TDA) Plan (TIAA-CREF)
  Salary Reduction Agreement Form (PDF)    
 
Tuition Waver Application
   (PDF)   Tuition Waiver Application for Part-Time Faculty - Summer 2013 Semester (PDF)

Career Development Program [+]

Performance Appraisals [+]


  Administrative Staff and Union Employees
  Self-evaluation Form (DOC)  
Supervisor Evaluation Form (DOC) (for use by Supervisors)
  Evaluation Form Follow-Up (DOC)   Evaluation Form Follow-Up (for use by Employees)
  Senior and Executive Staff:
  Self-evaluation Form (DOC)
(Senior and Executive Staff)
  Supervisor Evaluation Form (DOC)
(Senior and Executive Staff)
 
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