Benefits Forms:

Form Name	Available Formats (Icon Legend)	Form Descriptions
Beneficiary Designation Form		To declare beneficiaries for basic life, accidental death and dismemberment, or supplemental life insurance.
Financially Interdependent Partners (FIP) Explanation		To explain and determine FIP eligibility.
Financially Interdependent Partners (FIP) Statement		To declare FIP eligibility.
FSA Claim For Medical And Dependent Care Form		To submit a claim for your flexible spending account.
FSA Direct Deposit For Medical And Dependent Care Form		To establish direct deposit of your flexible spending account payments.
Student Enrollment Verification/Dependent Health Care Eligibility		To verify student enrollment and/or to notify employees of dependent (child) health care coverage eligibility.
TDA Salary Reduction Agreement Form (version for 2008)		To establish or change contributions to a tax deferred annuity.
Tuition Waiver Request Form (UAA)		For use by eligible employees to waive tuition costs at UAA.
Tuition Waiver Request Form (UAF)		For use by eligible employees to waive tuition costs at UAF.
Tuition Waiver Request Form (UAS)		For use by eligible employees to waive tuition costs at UAS.
UA Choice Health Plan Enrollment Form - FY09 Open Enrollment		To enroll employee and dependents in UA health care plan for 7/1/08 through 6/30/09.
UA Choice Health Plan Enrollment Form - FY08		To enroll employee and dependents in UA health care plan for 7/1/07 through 6/30/08.
UA Choice Opt Out Form - FY09 Open Enrollment		To elect to opt out of UA health care coverage as of 7/1/08.
UA Choice Opt Out Form - FY08		To elect to opt out of UA health care coverage and verify proof of other insurance coverage for 7/1/07-6/30/08.
UA Choice Supplemental Benefit Election Form - FY09 Open Enrollment		To add or delete employee selected benefits and/or deductions - i.e., FSA, AD&D, and other employee selected deductions such as accounts payable, parking, United Way, etc. (7/1/08-6/30/09).
UA Choice Supplemental Benefit Election Form - FY08		To add or delete employee selected benefits and/or deductions - i.e., FSA, AD&D, and other employee selected deductions such as accounts payable, parking, United Way, etc. (7/1/07-6/30/08).
Wolfcard Payroll Deduction Form (UAA Employees Only)		To request a payroll deduction to credit your UAA Wolfcard.

Please email syhr about any problems with this page   21-Apr-2008

  Photo credits: woman in field class and woman at Sitka campus photos courtesy of UAS; Mt. McKinley photo credit © Rex Melton,
Alaska Division of Tourism; flower photo credit Nile Mueller; aurora photo credit Jan Curtis 2003