Benefits Forms

• Retirement

  TIAA-CREF Change in Beneficiary Form

• Health Insurance

  Authorization for Release of Information Form
  Student Verification Form
  Change in Status Form
  

• Life Insurance

  Evidence of Insurability Form
  Optional and Dependent Life Insurance Enrollment Form
  PEIA Basic/Optional Life Insurance Change of Beneficiary Form
  

• Long-Term Disability Insurance

  Long-Term Disability Enrollment Form
  Long-Term Disability Cancellation Form
  

• Leave Benefits

  Request for Personal Leave of Absence
  Catastrophic Leave Donor Application
  Catastrophic Leave Recipient Application
  Medical Verification Leave Form
  Immediate Family Member Form - Medical Verification Leave Form
  Leave Extension Request Form (Word)
  Personal Leave of Absence Request (Word)

• Supplemental Retirement Accounts (SRAs)

  Cancellation Form
  Supplemental Retirement Account - Salary Reduction Agreement
  

  403b Enrollment Forms

  Great West
  TIAA-CREF
  

  457b Enrollment Forms

  Great West
  TIAA-CREF
  

• Years of Service

  Request for Years of Service Verificaton
  

• Flexible Spending Account

  Debit Card Receipt Transmittal Form
  Reimbursement Request Form