Benefits Enrollment

General Forms

• Enrollment and Policy Change ( PDF)
• Benefit Plan Withdrawal Form ( PDF)
• Name and Address Change Form ( PDF)
• Personal Data Form ( PDF)
• University Beneficiary Change Form ( PDF)
• Verification of Student Status ( PDF)
• Same Sex Domestic Partner Relationship Declaration ( PDF)
• Same Sex Domestic Partner Relationship Termination Form ( PDF)
• Washington DC Health and Dental Enrollment ( PDF)

Health and Dental Plans

• Retiree Health, Cobra Health
• Retiree Dental, Cobra Dental
• Leave of Absence Health
• Leave of Absence Dental
• Visiting Scholar Health Enrollment
• Visiting Scholar Dental Enrollment
• Blue Cross Statement of Dental Condition

Retirement Plans

• 2006 Retirement Plan Enrollment and Contribution Change
• Fidelity Investments Application, Beneficiary Designation, and other Fidelity Forms
• TIAA-CREF Applications, TIAA-CREF Beneficiary Designation
• Financial Hardship Application

Flexible Spending Account (FSA)

• Current FSA Forms for Health and Dependent Care

Life Insurance

• Life Insurance Forms for Standard Insurance Company

Long Term Care (LTC)

• Long Term Care - Applications

Disability Applications and Forms (Short term, long term)

• Short Term Disability (STD)
• Long Term Disability (LTD)