Benefit Changes

(Qualifying Life Events)

• Request to Change Benefit Elections

• Medical Expense Claim Form

• UCCI Dental Enrollment Form

• Affidavit of Common Law Marriage - Employee
• Affidavit of Common Law Marriage - Spouse
• Affidavit of Domestic Partnership
• Affidavit of Tax Qualified Dependent
• Statement of Termination of a Domestic Partnership
• Tax Information on Health Benefits for Domestic Partners

• Office of the Provost FMLA Leave Accommodation Request Form for Faculty
• Lehigh University Faculty and Staff FML Request Form
• FMLA Certification of Health Care Provider

• Health Care FSA Form (generic)
• Dependent Care FSA Form (generic)
• FSA Sample Expense Eligibility
• Ceridian FSA Ineligible and Eligible Expenses

• Leave of Absence Form

• Medical Enrollment/Change Application

• Mortgage Incentive Program - Employee Payment Form

• Personal Information Change Form (Word)
• Personal Information Change Form (pdf)

• Walgreens Prescription Claim Reimbursement Form

• For Employees
• For Supervisors

• 2008-09 Tuition Cash Grant Application
• 2008-09 Tuition Cash Grant Fact Sheet

• Davis Vision Claim Form

• Salary Reduction Agreement - 2008 (Word)

• Salary Reduction Agreement - 2008 (Word form)
• Salary Reduction Agreement - 2008 (pdf)

• Request for Reasonable Accommodation
• Medical Information Request and Verification Form

• Problem Solving Process Form

• Affirmative Action Compliance Form (word)

• Applicant Log

• Employment Application (internal nonexempt positions)
• Employment Application (external nonexempt positions)
• Employment Application (external exempt positions)

• Faculty Employment Request Form
• Staff Employment Request Form (pdf)
• Staff Employment Request Form (word)

• Form I-9, Employment Eligibility Verification

• Job Posting Form

• Request for Reference and Release
• Separation Information Sheet
• Supervisor's Separation Plan Checklist

• HR Notification of Termination Form

• Nomination Form (pdf)
• Nomination Form (word)

• Tradition of Excellence Nomination Form (on-line)
• Tradition of Excellence Nomination Form (pdf)
• Tradition of Excellence Nomination Form (word)

• Extra Duty Form (pdf)
• Extra Duty Form (word)

• On-Campus Consulting Form (pdf)
• On-Campus Consulting Form (word)

• How to access your position description

• Position Re-evaluation Request Form (word)
• Position Re-evaluation Request Form (pdf)

• Staff Request to Abstain from Deferred Pay Program

• Predated Timesheets (nonexempt and exempt staff)
• Special Rates Timesheets

• BEST Program Registration Form (pdf)
• BEST Program Registration Form (word)

• 2008-09 Performance Appraisal Schedule
• GPS Performance Management Resources
• Performance Improvement Plan Form
• Self-Appraisal Preparation Form
• Success Factor Worksheet - Core
• Success Factor Worksheet - Managerial

• Make the Most of Training - Employees
• Make the Most of Training - Supervisors
• Training Registration Form

• HealthSCAN form