Forms
The forms below are organized by category. If you know the name of the form you are looking for, you may also search for it in the A to Z list of forms.
Benefits
Health & Welfare
Claim Forms
- Maroon Plan Claim Form
- MetLife Dental PPO Plan Claim Form
- MetLife Dental Copay Plan Claim Form
- Retiree Medical Claim Form
Primary Care Physician
Retirement Plans
ERIP
CRP
SRP
Retiree Medical
Domestic Partnership
Leaves of Absence & Workers' Compensation
- Accrual Use Option (Workers' Compensation)
- Certification of Employee Health Care Provider (FMLA)
- Certification of Family Health Care Provider (FMLA)
- Leave Request Form
- Healthcare Provider Statement (Not FMLA eligible)
- Release of Medical Information (Workers' Compensation)
- Request for Treatment Form 100 (Workers' Compensation)
- Supervisor's First Report - Claim of Injury/Illness (Workers' Compensation)
- Temporary Seasonal Shutdown Stipend TSSS Form
- VESSA Leave Request Form
- WH 384 Certification for Qualifying Exigency (Military FMLA)
- WH 385 Certification for Current Service Member Injury or Illness (Military FMLA)
- WH 385V Certification for Veteran Service Member Injury or Illness (Military FMLA)
- Rights and Responsibilities (Workers' Compensation)
- Employee Statement of Injury/Illness (Workers' Compensation)
Tuition Assistance
- Faculty Children's Scholarship Plan - Active
- Faculty Children's Scholarship Plan - Retiree
- Employee Child Application - Lab School
- Staff Child Application - The College
- Staff Tuition Assistance Application at the University of Chicago
- Staff Tuition Assistance Application Outside of the University of Chicago
Transition
For materials related to Transition, please contact your unit/department's HR Partner.
HR Professionals, please visit HR Connect to access forms related to Separations.