Human Resources
Forms
Benefit Forms
Regence PPO Medical Claim Form (pdf)
Regence PPS Mail Order Form (pdf)
Regence Walgreens Mail Order Form (pdf)
Regence Transition of Care Form (pdf)
Domestic Partners/Marriage Affidavit (word doc)
Termination of Marrage/Domestic Partnership Form (word doc)
Group Life Beneficiary Form (word doc)
Pioneer Authorization Release Health Information (word doc)
RegenceRx Prior Authorization Release Form (pdf)
TIAA-CREF Beneficiary Form
TIAA-CREF Salary Reduction Form (word doc)
TIAA-CREF Change of Name Form (pdf)
Travel Insurance Beneficiary Form (word doc)
Employment
Employment Application (word doc)
Staff Departure Form (word doc)
Enrollment Forms
Medical and Dental (pdf)
Flexible Spending Account Enrollment (pdf)
Life Insurance Enrollment Form (word doc)
Voluntary Benefits Enrollment Form (word doc)
TIAA-CREF Defined Contribution Retirement Plan (Employer Paid) Online Enrollment
TIAA-CREF Tax Deferred Retirement Annuity Plan (Employee Contribution) Online Enrollment
Flexible Spending Account Reimbursement Forms
Medical Expense Flex Claim Form (pdf)
Child Care Expense Claim Form (pdf)
Family Medical Leave
Faculty Request for Leave Form (word doc)
Staff Request for Leave Form (word doc)
Workers' Compensation
Claim Form (pdf)
Accident/Incident Report (word doc)
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