Forms

Below are electronic versions of the forms in use by Human Resources including Summary Plan Descriptions (SPDs) for our benefit plans.

You'll need the Adobe Acrobat Reader to access these files:

• New Employee Orientation Presentation
  
• Bonus Compensation Form
  
• Promotional Bid and Transfer Form
  
• Disciplinary Action Form
  
• Faculty and Staff Assistance Program (FASAP) Plan SPD
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• Federal Family Medical Leave Act (FMLA) Forms

                       Request for FMLA
                       Authorization for Release of Health Information
                       Family Medical Leave (FML) Checklist
                       Designation Notice
                       Employee's Serious Health Condition
                       Family Member's Serious Health Condition
                       Certification of Qualifying Military Exigency
                       Certification for Serious Injury or Illness of Covered Servicemember

• Short-term Disability (STD) Claim Form
  
• EHP Medical or Vision Claim
  
• EHP Dental Claim (United Concordia)
  
• Flexible Spending Account Information & Claim Forms
• Prescription Mail Order
• Prescription Primary Claim
• Prescription Secondary Claim
• Non-Represented Employees Benefits Plan SPD
  
• 403(b) Opt Out Form
• Non-Represented Employees 403(b) Plan SPD
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• Employee Tuition Form
• Dependent Child Tuition Form
• Direct Deposit Form
• Direct Deposit Cancellation Form
• Federal W-4 Form
• Maryland MW 507 Form
• Identification Badge Request Form
• Employee Tuition Form