海角社区

Skip to main content

Health Insurance

NYS Health Insurance Transaction Form (PS-404)
NYS Health Insurance Opt-Out Attestation (PS-409) -
NYS Health Insurance Domestic Partner Packet (PS-425 series) -
Pre-Tax Contribution Program Fact Sheet -

Employees' Retirement System (ERS):

  • ERS Membership Application -
  • ERS Designation of Beneficiary Form -

Teachers Retirement System (TRS):

  • TRS Membership Application -

Other Benefits

B-140W Application for Tuition and Fee Assistance - PDF

Request for Appendix A-28 Promotion and/or Salary Increase (UUP) - PDF

Address/Telephone/Name Change Form - PDF
Agility Waiver and campus map for University Police 1 Applicants
Authorization for Release of Health Information Pursuant to HIPAA - PDF
Bereavement Form - PDF

Information Release Form - PDF
Leave of Absence (Family or Medical) *Employees must contact Human Resources for consultation*
Family & Medical Leave Request Form - PDF
Medical Certification Forms - , , ,
Medical Certification Form in Response to an Accommodation Request - PDF
Voluntary Reduction in Work Schedule (VRWS) Application - PDF
Voluntary Reduction in Work Schedule (VRWS) Schedule for Use of VR credit - PDF

Dual Employment Form, UP-8 -

Human Resources Office

  • 511 Maytum Hall 海角社区 Fredonia, NY 14063