Forms

Use the search box below to filter the forms table by keyword.

If you need assistance locating a form, contact HR Shared Services at 315.443.4042.

CategoryForm Name
COVID-19: Medical ExemptionHealth Care Provider Certification of Medical Exemption from SU Employee COVID-19 Vaccination Requirement
Benefits: Claim FormsExcellus BCBS Claim Form
Benefits: Claim FormsExcellus BCBS International Claim Form
Benefits: Claim FormsOptumRx Prescription Reimbursement Form
Benefits: Claim FormsOptumRx Prescription Drug Home Delivery Order Form
Benefits: Claim FormsWageWorks - Health Care Flexible Spending Account (FSA) Claim
Benefits: Claim FormsWageWorks - Dependent Care Flexible Spending Account (FSA) Claim Form
Benefits: Claim FormsDelta Dental Claim Form
Benefits: Claim FormsAdoption Assistance Reimbursement Form
Benefits: Claim FormsHIPAA Authorization Form for Use and Disclosure of Protected Health Information
Benefits: Claim FormsMetLife Beneficiary Designation for Life Insurance Benefits
Benefits: Applications/Enrollment FormsDeclaration of Marriage, Domestic Partnership, or Civil Union
Benefits: Applications/Enrollment FormsTermination of Domestic Partnership Form
Benefits: Applications/Enrollment FormsDependent Add/Drop Form
Benefits: Applications/Enrollment FormsDependent Care Subsidy Application Process
Benefits: Applications/Enrollment FormsMetLife Request for Auto/Home Insurance Quote
Benefits: Applications/Enrollment Forms Schedule B Reduced Medical Contribution Application Process
Benefits: Applications/Enrollment FormsStatement of Health for MetLife Insurance Approval (use for late enrollment or increase in coverage)
Benefits: Applications/Enrollment FormsMedical History Statement for Long Term Disability Coverage through The Standard (use for late enrollment)
Benefits: TIAA Retirement AccountSalary Reduction Form: 403(b) Voluntary Retirement Plan (use to indicate the amount to be deducted from your paycheck to contribute to your 403(b) account)
Benefits: TIAA Retirement AccountSalary Reduction Form: 457(b) Deferred Compensation Form (use to indicate the amount to be deducted from your paycheck to contribute to your 457(b) account)
Benefits: TIAA Retirement AccountTIAA Waiver Letter and Form
Benefits: TIAA Retirement AccountTIAA Enrollment Form for Voluntary 403(b) Account (use to establish an account at TIAA to hold your contributions to your retirement)
Benefits: TIAA Retirement AccountTIAA Enrollment Form for Noncontributory Retirement Plan (use to establish an account at TIAA to hold the University's contributions to your retirement)
Benefits: TIAA Retirement AccountTIAA Enrollment Form for 457(b) Deferred Compensation Plan (for eligible individuals to establish a deferred compensation account at TIAA)
Benefits: Tuition ProgramsRemitted Tuition Credit Allocation
Benefits: Tuition ProgramsDependent Tuition Benefit Application Process
Benefits: Tuition ProgramsTuition Exchange EZ Application
Benefits: RetireesLifetime Benefit Solutions Automatic Payment (ACH) Request Form
Benefits: RetireesRetiree Medical Election Form
Benefits: RetireesRetiree - Opt-In Medical Form
Benefits: RetireesRetiree - Opt-Out Medical Form
Employee InformationPersonal Information Form (PIF)
Employee InformationName Change Form
CompensationPay Notification: Exempt
CompensationPay Notification: Faculty
CompensationPay Notification: Non-Exempt
CompensationPay Notification: Non-Exempt SEIU Bargaining Unit
CompensationPay Notification: User Instruction Memo
CompensationPosition Evaluation Request (PER) Template
SEIU Bargaining UnitSEIU Bargaining Unit: Business Authorization/Time Record
SEIU Bargaining UnitSEIU Bargaining Unit: Dues Deduction, Initiation Fee and Assessment Authorization
SEIU Bargaining UnitSEIU Bargaining Unit: Affidavit of Opposite Sex Domestic Partnership
SEIU Bargaining UnitSEIU Bargaining Unit: Statement of Termination of Domestic Partnership
Leave of Absence & DisabilityRequest for Paid Family Leave to Bond with a Child
Leave of Absence & DisabilityRequest for Paid Family Leave to Care for a Family Member with a Serious Health Condition
Leave of Absence & DisabilityRequest for Paid Family Leave for a Military Exigency
Leave of Absence & DisabilityApplication for Disability/Maternity Benefits
Leave of Absence & DisabilityReturn to Work: Faculty
Leave of Absence & DisabilityReturn to Work: Staff
Leave of Absence & DisabilityHealth Care Provider Release Form
Leave of Absence & DisabilityReasonable Accommodation Request
OtherData Request Form
PayrollDirect deposit, tax withholding, reissue of W-2 forms, and more can be found under Payroll forms on the Business, Finance, and Administrative Services (BFAS) Forms page.
Performance PartnershipPerformance Partnership Form
Termination/RetirementFaculty Voluntary Phased Retirement Form
Termination/RetirementEmployee Separation Checklist
WorklifeFlexible Work Arrangement Form