| 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. |
| Campus Card Deduction Form |
|
To request a payroll deduction to credit
a campus card (UAA Wolfcard, UAF Polar Express card, and/or UAS Whale Card). |
|
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 Form |
|
To establish or change contributions to
a tax deferred annuity. |
| (Tuition) Waiver Request - UA Education Benefit |
|
For use by eligible employees for the UA employee education benefit. |
| UA Approved Non-credit Courses for Fall 2009 |
|
UA approved non-credit courses for Fall 2009 that qualify for the UA employee education benefit. |
| UA Approved Certified Public Manager (CPM) Courses |
|
UA approved CPM courses that qualify for the UA employee education benefit. |
UA Choice Enrollment Guide
(For coverage effective as of July 1, 2009.) |
|
UA Choice Enrollment Guide for plan period of July 1, 2009, through June 30, 2010. |
UA
Choice Health Plan Enrollment Form - FY10
(For coverage period of July 1, 2009, through June 30, 2010.) |
|
To enroll employee and dependents
in the UA health care plan for the plan period of July 1, 2009, through June 30, 2010. |
UA
Choice Opt Out Form - FY10
(For plan period of July 1, 2009, through June 30, 2010.) |
|
To elect to opt out of UA health care coverage during the plan period of July 1, 2009, through June 30, 2010. |
UA
Choice Supplemental Benefit Election Form - FY10
(For coverage period of July 1, 2009, through June 30, 2010.) |
|
To add or delete employee selected benefits
and/or deductions (e.g. FSA, AD&D, Supplemental Life) during the plan period of July 1, 2009, through June 30, 2010. |
UA Supplemental Life Evidence of Insurability (EOI) Form - FY10
(For coverage period of July 1, 2009, through June 30, 2010.) |
|
Employees electing more than $200,000 in supplemental life coverage are required to complete the evidence of insurability form and submit it to their HR office along with with the UA Choice Supplemental Benefit Election Form. |
| Waiver Request - UA Education Benefit |
|
For use by eligible employees for the UA employee education benefit. |
| UA Approved Non-credit Courses for Fall 2009 |
|
UA approved non-credit courses for Fall 2009 that qualify for the UA employee education benefit. |
| UA Approved Certified Public Manager (CPM) Courses |
|
UA approved CPM courses that qualify for the UA employee education benefit. |
