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Forms

MANAGERS: Need forms related to hiring, performance management, attendance or termination? Visit the Manager Toolkit Forms page.

Note: To ensure you can download the latest version of our PDF files,please clear your browser's cache before downloading.  

BENEFITS FORMS

DISABILITY AND WORKERS' COMPENSATION FORMS

VOLUNTARY SELF-IDENTIFICATION FORMS

Benefits Forms

Flexible Spending Accounts (FSAs)
  • FSA Reimbursement Request Form (PDF/Word)
  • FSA Direct Deposit Form (PDF)

 

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Flexible Work Arrangement Proposal Form
  •  Flexible Work Arrangement Proposal Form (Word)

 

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Transit/Parking Reimbursement Program (T/PRP)
  • T/PRP Reimbursement Form (PDF/Word)

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Dental
  • Aetna Columbia Dental Plan Claim Form (PDF)
  • GHI Claim Form (PDF)

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Healthcare
  • Aetna
    • Aetna Medical Claim Form (PDF)
    • Aetna Vision Claim Form (PDF)
    • Aetna Transition of Care Form (PDF)
  • CIGNA
    • CIGNA Behavioral Care Out of Network Claim Form (PDF)
    • CIGNA Medical Claim Form (PDF)
    • CIGNA PCP Selection Form (Word)
    • CIGNA Student Verification Form (PDF)
    • CIGNA Transition of Care Form - not including mental health (PDF)
    • CIGNA Transition of Care Form - includes mental health (PDF)
  • HIP
    • HIP Subscriber/Member Enrollment Form (PDF)
  • UnitedHealthcare
    • UnitedHealthcare Medical Claim Form (PDF)
    • UnitedHealthcare Transition of Care Form (PDF)

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Prescriptions
  • MEDCO Prescription Drug Claim Form (PDF)
  • Express Scripts Prescription Drug Benefits Coverage Request Form (PDF)
  • Express Scripts Prescription Drug Mail Order Form (PDF)

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Retirement Savings

Once you enroll online using the CU Benefits Enrollment System, please be sure to complete a separate enrollment form for the investment carrier(s) you choose.  The carrier enrollment form lets you select investment funds for your retirement accounts. TIAA-CREF and Vanguard are the investment carriers you can choose from.   

The CU Retirement Plan allows you to direct the investment of the University’s contribution to your account to one of these investment carriers.

The Voluntary Retirement Savings Plan (VRSP)  allows you to direct the investment of your own contributions to one or both of these investment carriers.  

If you decide to move your funds from one carrier to another carrier or transfer a portion of your funds from one carrier to another carrier, please complete an “Asset Transfer” form or the “Transfer, Rollover or Exchange Form” for TIAA-CREF.

TIAA-CREF:
  • TIAA-CREF Instructions for Enrolling Online (PDF)
  • TIAA-CREF Columbia University Retirement Plan Enrollment Form - Officers (PDF)
  • TIAA-CREF Enrollment Form for Support Staff Delayed Vesting Plan – Non-Union Support Staff and Supporting Staff Association (PDF)
  • TIAA-CREF Enrollment Form for Voluntary Retirement Savings Plan (VRSP) -  All Eligible Employees (PDF)
  • TIAA-CREF Transfer, Rollover or Exchange Form - All Eligible Employees (PDF)

Vanguard:

  • Vanguard Columbia University Retirement Plan Enrollment Form - Officers (PDF)
  • Vanguard Columbia University Retirement Plan Enrollment Form – Non-Union Support Staff and Supporting Staff Association (PDF)
  • Vanguard Columbia University Retirement Plan Asset Transfer Form – Non-Union Support Staff and Supporting Staff Association (PDF)
  • Vanguard Enrollment & Beneficiary Designation Form for Voluntary Retirement Savings Plan (VRSP) -  All Eligible Employees (PDF)
  • Vanguard Rollover Contribution Form for Voluntary Retirement Savings Plan (VRSP) -  All Eligible Employees (PDF)

 

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Life Insurance
  • The Standard: Beneficiary Designation Form (PDF)
  • The Standard: Evidence of Insurability for CT Residents (PDF)
  • The Standard: Evidence of Insurability for NJ Residents (PDF)
  • The Standard: Evidence of Insurability for NY Residents (PDF)

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Tuition
Tuition Exemption at Columbia schools
  • Officers and Support Staff: Print your Tuition Exemption Eligibility Form from the CU Online Benefits Enrollment System
  • “Student in Good Standing” Sample Letter for College Tuition Scholarship and Summer Tuition Exemption for Children (Word)
  • Tuition Exemption Application - Retirees (Hired After 1993) (PDF/Word)
  • Tuition Exemption Application - Officers and Retirees Hired Pre-1993 (PDF/Word)
  • Job-Related Graduate Education Certification Policy (PDF / Word)
    • Instructions for Employees (PDF / Word)
    • Instructions for Supervisors (PDF / Word)
    • Job-Related Graduate Education Certification Form - Degree Program (PDF / Word)
      Fill out the Degree Program form if your graduate coursework is part of a master's or post-baccalaureate degree program.
    • Job-Related Graduate Education Certification Form - Non-Degree Program (PDF / Word)
      Fill out the Non-Degree Program form if your graduate coursework (4000 and above) is not part of a degree program.

Tuition Benefits for Officers' Dependent Children at Schools Outside Columbia

  • Officers and Retired Officers: College Tuition Scholarship (CTS) Checklist and Forms
    • CTS Checklist for all applicants (PDF/Word)
    • Active Officers: Print your CTS Form from the CU Online Benefits Enrollment System
    • Retired Officers: CTS Application Form (PDF/Word)
    • “Student in Good Standing” Sample Letter for College Tuition Scholarship and Summer Tuition Exemption for Children (Word)
  • Officers and Retired Officers: Primary Tuition Scholarship (PTS) Checklist and Forms
2110 Tuition Program
  • 2110/CU Tuition Assistance Application (PDF)

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Post-Doctoral Fellows
  • Post-Doctoral Medical Benefits Enrollment Form (PDF/Word)
  • Tuition Exemption Application (PDF/Word)

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Adoption
  • Adoption Assistance Form (PDF/Word)

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HIPAA
  • HIPAA Privacy Authorization Form (Word)

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Disability and Workers' Compensation Forms

  • Department Accident Report (PDF)
  • Disability Release (PDF)
  • NY State Disability Form DB 450 (PDF)
  • Request for Reasonable Accommodation (PDF)

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Voluntary Self-Identification Forms

  • Voluntary Self-Identification: Disability (Word
  • Voluntary Self-Identification: Veteran (Word)

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Forms & Documents Contents