Human Resources banner image Human Resources banner image Human Resources Human Resources banner image banner image
HR HOME Benefits Class. & Comp. Employment Forms Labor Relations Training UA Online HR Picklist

Forms Pages Links:

A-Z Forms Index
Benefits Forms
Employment Forms
Ethics Forms
FSA Forms
Health Forms
Leave Forms
NRA Forms
Payroll Forms
Retirement Forms
Risk/Safety Forms
Union Forms

Internal Use Forms:

Payroll Forms
Personnel Forms

Quick Links:

HR Contacts
HR Staff
UA Policy & Regs

Login >
UA Statewide Employee Forms (Benefits)
Click here to get Adobe Acrobat Reader.

HR Employee Forms

Benefits Forms:

Form Name Available Formats
(Icon Legend)
Form Descriptions
Beneficiary Designation Form Adobe PDF format file Computer enterable Adobe PDF format file To declare beneficiaries for basic life, accidental death and dismemberment, or supplemental life insurance.
Campus Card Deduction Form Adobe PDF format file 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

Adobe PDF format file To explain and determine FIP eligibility.

Financially Interdependent Partners (FIP) Statement

Adobe PDF format file To declare FIP eligibility.

FSA Claim For Medical And Dependent Care Form

Adobe PDF format file To submit a claim for your flexible spending account.

FSA Direct Deposit For Medical And Dependent Care Form

Adobe PDF format file To establish direct deposit of your flexible spending account payments.
Student Enrollment Verification/Dependent Health Care Eligibility Adobe PDF format file Computer enterable Adobe PDF format file To verify student enrollment and/or to notify employees of dependent (child) health care coverage eligibility.
TDA Salary Reduction Agreement Form Form Computer enterable Adobe PDF format file To establish or change contributions to a tax deferred annuity.
(Tuition) Waiver Request - UA Education Benefit Adobe PDF format file For use by eligible employees for the UA employee education benefit.
UA Approved Non-credit Courses for Fall 2009

Adobe PDF format file

UA approved non-credit courses for Fall 2009 that qualify for the UA employee education benefit.
UA Approved Certified Public Manager (CPM) Courses

Adobe PDF format file

UA approved CPM courses that qualify for the UA employee education benefit.
UA Choice Enrollment Guide
(For coverage effective as of July 1, 2009.)
Adobe PDF format file 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.)
Adobe PDF format file 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.)
Adobe PDF format file 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.)
Adobe PDF format file 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.)
Adobe PDF format file 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 Adobe PDF format file For use by eligible employees for the UA employee education benefit.
UA Approved Non-credit Courses for Fall 2009

Adobe PDF format file

UA approved non-credit courses for Fall 2009 that qualify for the UA employee education benefit.
UA Approved Certified Public Manager (CPM) Courses

Adobe PDF format file

UA approved CPM courses that qualify for the UA employee education benefit.

University of Alaska campuses online services searches System Offices