If you have recently visited our site to obtain a form using Internet Explorer, please delete your temporary internet files.  On your Internet Explorer menu, click "tools" and then "internet options".  Under the General tab, temporary internet files, then click "delete files".  This will allow you to obtain the most recent copy of the form. 

Can't find the form you want?  Please scroll down to see all forms.  If you don't see it here, feel free to contact Benefits at x12220 for assistance.

Adoption
Adoption Assistance Request for Payment

Dental
Delta Dental Claim Form

Disability 
Short-Term Disability Income Application

Family and Medical Leave Act (FMLA)
Certification of Health Care Provider (Self)
Certification of Health Care Provider (Family)
Certification of Qualifying Exigency (Military Family Leave)
Certification of Serious Injury/Illness (Military /Covered Service Member)

Flexible Spending
Health Care Account Reimbursement Request form
Dependent Care Account Reimbursement Request form
FSA Enrollment Form
FSA Expense Lists and Worksheet (UMR)
FSA Mileage Form (UMR)
FSA Direct Deposit Authorization Form

Life Insurance
Faculty/Staff Additional Life Coverage Highlights
The Standard Life Insurance Enrollment Form
Life Application Insurability
Life Insurance Beneficiary & Name Change Form
Standard Group Life Conversion Request Form
Standard Group Life Portability Form

Medical & Prescription
Medical Plan Enrollment Form
Household Member Enrollment Form  
UMR Medical Reimbursement Form
Caremark Mail Order Prescription Form
Caremark Prescription Reimbursement Form

Payroll
Direct Deposit Form  
United Way / GVSU Pledge Card  

Retirement & Supplemental Retirement
Terminate/Cancel Salary Reduction Agreement
403b Supplemental Retirement Account Salary Reduction Agreement
457b Supplemental Retirement Account Salary Reduction Agreement
Allocation of University Retirement Contributions/Waiver of 2-year Vesting Period (Hourly) 
Allocation of University Retirement Contributions/Waiver of 2-year Vesting Period (Salaried)
Beneficiary Designation for Death Benefit (hourly staff only)
Fidelity Beneficiary Designation Form
Fidelity Change of Address
TIAA-CREF Beneficicary Designation Form
TIAA-CREF Change of Name Form
TIAA-CREF Change of Address

Tuition
Employee Academic Participation Form
Tuition Reduction Form for Spouse and Dependent

Vacation
All vacation reporting is done on Ultratime.  Click here to log in and record your vacation hours.

Vision
EyeMed Out-of-Network Claim Form 

Workers Compensation
Workers' Compensation Injury Report