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

• Flexible Spending Accounts (FSAs)
• Flexible Work Arrangement Proposal Form
• Transit/Parking Reimbursement Program (T/PRP)
• Dental
• Healthcare
  • Aetna
  • CIGNA
  • HIP
  • UnitedHealthcare
• Retirement Savings
• Prescriptions
• Life Insurance
• Tuition
• Post-Doctoral Fellows
• Adoption
  
• HIPAA
  
  

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)

To Top

Flexible Work Arrangement Proposal Form

•  Flexible Work Arrangement Proposal Form (Word)

To Top

Transit/Parking Reimbursement Program (T/PRP)

• Parking Payroll Deduction Authorization (PDF/Word)
• T/PRP Reimbursement Form (PDF/Word)

To Top

Dental

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

To Top

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)

To Top

Prescriptions

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

To Top

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 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)

To Top

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)

To Top

Tuition

• Print your Tuition Benefit Form from the CU Online Benefits Enrollment System
• Officers - College Tuition Scholarship (CTS) Checklist and Application Form (PDF/Word)
• Officers - Primary Tuition Scholarship (PTS) Checklist and Application Form (PDF/Word)
  • Primary Tuition Scholarship Application Form for the K-8 School at Columbia (PDF/Word)
• Tuition Exemption Application - Retirees (Hired After 1993) (PDF/Word)
• Tuition Exemption Application - Officers and Retirees Hired Pre-1993 (PDF/Word)
• Job-Related Graduate Course Certification Application Form (PDF/Word)
• 2110/CU Tuition Assistance Application (PDF)

  To Top

Post-Doctoral Fellows

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

To Top

Adoption

• Adoption Assistance Form (PDF/Word)

To Top

HIPAA

• HIPAA Privacy Authorization Form (Word)

To Top

Disability and Workers' Compensation Forms

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

To Top

Voluntary Self-Identification Forms

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

To Top