Employee Benefit Forms
- 403b Salary Reduction Agreement
- Academic Assistance: Tuition Reimbursement
Request
- Academic Assistance: Tuition Waiver Form at State Universities
- Benefits Eligibility Chart
- Employee Address Change
- Employee Name Change
- FMLA
(Family & Medical Leave Act) Certification
- Contact Employee Relations at 966-2261 for FMLA questions.
- Leave Request Authorization
- Liberty Mutual Supplemental Disability: Enrollment Application
- Liberty Mutual Supplemental Disability: Evidence Of Insurability
- Liberty Mutual Supplemental Disability: Premium Calculation Worksheet
- MetLife Life Insurance: Affidavit of Domestic Partnership
- MetLife Life Insurance: Change of Beneficiary
- MetLife Life Insurance: Enrollment Application
- MetLife Life Insurance: Premium Calculation Worksheet
- MetLife Life Insurance: Statement of Health
- Miscellaneous Cancellation Form
- NC Flex Benefit Change Instructions
- NC Flex Claim Form: Dental Care
- NC Flex Claim Form: Flexible Spending/Day Care
- NC Flex Claim Form: Vision Care
- NC Flex HIPAA Authorization
- NC Flex Group Term Life Insurance Evidence of Insurability
- State Health Plan Change
- State Health Plan Enrollment Application
- State Health Plan HIPAA Authorization
- State Health Plan Medical Claim Form (PPO)
- State Health Plan Prescription Claim Form
- State Health Plan Prior/Other Coverage Information
- State Retirement System Change of Beneficiary
- Voluntary Shared Leave Donor Form
- Voluntary Shared Leave Program Summary
