Forms

Frequently Requested Forms

• Address Change Form (you must also complete a PA Earned Income Tax Form and send to Payroll)
• Attendance Record (track paid time off – vacation, personal, sick, etc.)
• Gym/Library Application for Spouses
• Payroll Forms (tax & direct deposit)
• Performance Coaching Input ("Yellow") Sheet - Word or PDF
• Public Transportation Vouchers - TransitChek/RideECO Election Form
• Timesheet - Bi-weekly
• Timesheet - Monthly
• Tuition Grant Application
• Tuition Remission Form

Medical, Vision & Health Savings Account (HSA)

• Flexible Benefit Plan Election Form
• Blue Cross Medical Enrollment Form
• Flu Shot Claim Form
• Davis Vision Claim Form
• Health Savings Account (HSA) Election Form
• Health Savings Account (HSA) HealthEquity New Account Form

Dental

• Dental Election Form
• Delta Dental Enrollment Form

Flexible Spending Accounts (FSA)
*** PLEASE NOTE THAT WHILE A "PAPER" CLAIM FORM IS AVAILABLE, IT IS RECOMMENDED YOU SUBMIT CLAIMS DIRECTLY THROUGH THE PAYFLEX PORTAL ***

• Flexible Spending Account (FSA) Election Form
• Flexible Spending Account (FSA) Claim Form

Life Insurance

• Life Insurance Beneficiary Form
• Life Insurance Enrollment/Change Form

Disability & Other Leaves

• Family Medical Leave Act (FMLA) Request Form
• Short Term Disability (STD) Application

Additional Benefits

• Flex-time Request Form
• Gym/Library Application for Spouses
• Public Transportation Vouchers - TransitChek/RideECO Election Form
• Tuition Grant Application
• Tuition Remission Form

Employment & Other

• I-9 Employment Eligibility Verification Form
• Address Change Form (you must also complete a PA Earned Income Tax Form and send to Payroll)
• Attendance Record (track paid time off – vacation, personal, sick, etc.)
• Emergency Contact Form
• Employee Information Sheet
• Job Posting Form
• Non-employee Information Sheet (volunteers, research associates, etc.)
• Performance Coaching 90 Day Review
• Performance Coaching Input ("Yellow") Sheet - Word or PDF
• Performance Coaching ("Blue") Worksheet - Word or PDF
• Performance Coaching Personal Development Plan ("Green Sheet") - Word or PDF (optional)
• Position Request Form
• Timesheet - Bi-weekly
• Timesheet - Monthly